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Logo of thijTexas Heart Institute JournalSee also Cardiovascular Diseases Journal in PMCSubscribeSubmissionsTHI Journal Website
 
Tex Heart Inst J. 2009; 36(2): 182–183.
PMCID: PMC2676601

Myocardial Metastatic Tumor from a Primary Oropharyngeal Carcinoma Presenting as Severe 3rd-Degree Atrioventricular Block

Raymond F. Stainback, MD, Section Editor
Department of Adult Cardiology, Texas Heart Institute at St. Luke's Episcopal Hospital, 6624 Fannin Street, Suite 2480, Houston, TX 77030

A 62-year-old man presented with syncope and electrocardiographically recorded 3rd-degree atrioventricular block with slow junctional escape ventricular rhythm of 35 beats/min. He had a history of squamous-cell oropharyngeal carcinoma; this malignancy had been treated by means of radical resection 12 months before. When temporary pacing was performed, resistance was encountered crossing the tricuspid valve. Transthoracic echocardiography revealed a large echogenic infiltration that involved the interatrial septum, the atria, and the posterior left ventricular wall (Figs. 1A and and1B).1B). The right atrium was moderately dilated, with a highly mobile, heterogeneous mass within its cavity (Fig. 1C). Computed tomography of the thorax revealed a diffuse, hypodense mass, posterior to the myocardium, with marked thickening of the proximal interventricular septum and the medial wall of the right atrium (Fig. 1D). The patient decided upon conservative treatment, in view of his guarded prognosis. He was referred for palliative hospice care.

figure 26FF1
Fig. 1 A) Transthoracic echocardiography (apical 4-chamber view) shows a large metastatic tumor, which presents as a large echogenic infiltration that involves the interatrial septum, the interventricular septum, the right atrium, and the posterior left ...

Comment

Although the most common cause of 3rd-degree atrioventricular block is degenerative in nature, the possibility of myocardial metastasis should be considered when complete atrioventricular dissociation is present in a patient who has a history of malignancies. Usually, myocardial metastases remain clinically dormant and are discovered only at autopsy.1 It is known from autopsy series that metastatic tumors of the heart can be found in 1.5% to 21% of patients who have malignancies. The most common cause of metastatic heart disease is bronchial carcinoma. In our patient's unusual circumstance, the 3rd-degree atrioventricular block was related to the disruption of the cardiac electrical conduction system by a giant metastatic tumor.

Footnotes

Address for reprints: Chao Yang Soon, MD, 960 Dunearn Rd., #01-26 Gardenvista, Singapore 589486, Singapore. E-mail: moc.liamg@ycnoos

References

1. Mocini D, Longo R, Colivicchi F, Morabito A, Gasparini G, Santini M. A complete atrioventricular block secondary to myocardial metastases of lung cancer. A case report. Ital Heart J 2005;6(11):931–2. [PubMed]

Articles from Texas Heart Institute Journal are provided here courtesy of Texas Heart Institute