一名84岁男子因全身无力和呼吸急促而被送往急诊室。心电图结果引起了对ST段抬高心肌梗死(STEMI)的担忧,患者被转移到配备有心导管室的医院。到达第二家医院后,患者没有胸痛。心电图显示导联I、aVL和V2至V6中的ST段抬高。肌钙蛋白I水平为0.15ng / ml。在与患者进一步讨论和对记录的回顾中,发现患者由于无意识的体重减轻而在1个月前住院。当时胸部的计算机断层扫描(CT)显示大量胸腔内肿块侵入左心室。住院期间CT引导穿刺活检显示低分化非小细胞癌。住院期间心电图显示ST段抬高类似,但在第二次入院时ST抬高更加明显。认为该情况是由于肿瘤侵袭心肌,并且未进行冠状动脉血管造影。在与患者及其家人讨论治疗方案后,决定不进行手术或化疗。治疗目标转为关注患者的舒适度。

An 84-year-old man presented to the emergency department with generalized weakness and shortness of breath. Electrocardiographic results aroused concern that he had an ST-segment elevation myocardial infarction (STEMI), and the patient was transferred to ahospital that had a cardiac catheterization laboratory. On arrival at the second hospital, the patient had no chest pain. An electrocardiogram showed ST-segment elevation in leads I, aVL, and V2 through V6. The troponin I level was 0.15 ng per milliliter. On further discussion with the patient and review of the records, it was discovered that the patient had been hospitalized 1 month earlier because of unintentional weight loss. CT (computed tomography) of the chest at that time revealed a large intrathoracic mass invading the left ventricle. CT-guided needle biopsy during that hospitalization revealed poorly differentiated non–small-cell carcinoma. An electrocardiogram during that hospitalization showed ST-segment elevations in a similar pattern, but they had become more prominent by the time of the second admission. This pattern was thought to be due to tumor invasion of the myocardium, and coronary angiography was not performed. After a discussion of treatment options with the patient and his family, the decision was made not to pursue surgery or chemotherapy. Goals of care were transitioned to focus on the patient’s comfort.