背景:尽管在诊断和治疗方面取得了进步,近几十年来,心脏转移的发生率有所增加。肺癌是最常见的具有心脏转移潜力的原发性恶性肿瘤。心脏转移的临床表现要么沉默,要么模糊,很大程度上取决于浸润位置和肿瘤负荷。尽管心律失常在转移性心脏肿瘤中并不少见,完全性心脏传导阻滞是一种相对罕见的表现。我们介绍了一例由于非洲裔67岁男性的转移性小细胞癌而导致的完全心脏传导阻滞。
方法:一名来自坦桑尼亚农村的67岁非洲裔男性被推荐给我们进行专家管理。他是一名退休的农业机械师,与含石棉的制动衬片接触超过30年。他过去的病史并不引人注目,但是家庭社会史是明显的大量饮酒和长期吸烟。他有24周的进行性呼吸急促史和8周的反复发作史,并伴有明显的体重减轻。他的超声心动图检查结果正常,然而,心电图显示完全心脏传导阻滞的特征.胸部X光显示右侧均匀混浊,计算机断层扫描显示右肺实性肿块并转移到肝脏,心,肠子,还有骨头.他做了支气管镜检查,显示支气管内肿块阻塞了中间支气管。在支气管镜检查期间进行的肺活检切片的组织学检查证实了小细胞癌的诊断。患者接受了双腔起搏器植入术,并成功恢复了窦性心律。他在知情的情况下拒绝化疗,并不可避免地在起搏后18个月死亡。
结论:尽管在医疗诊断和管理方面取得了进步,肺癌通常被诊断为晚期,不可避免的严重预后。小细胞癌有可能转移到心脏,导致完全的心脏传导阻滞。
BACKGROUND: Notwithstanding the diagnostic and therapeutic advancements, the incidence of cardiac metastases has increased in recent decades. Lung cancers are the most common primary malignant neoplasms with cardiac metastasis potential. The clinical presentation of cardiac metastases is either silent or vague, and largely depends on the infiltrated location and tumor burden. Although arrhythmias are not uncommon in metastatic cardiac tumors, complete heart block is relatively a rare manifestation. We present a case of complete heart block due to a metastatic small cell carcinoma in a 67-year-old male of African origin.
METHODS: A 67-year-old male of African origin from rural Tanzania was referred to us for expert management. He is a retired agromechanic with over 30 years exposure to asbestos-containing brake linings. His past medical history was unremarkable, but the family-social history was evident for a heavy alcohol intake and chronic cigarette smoking. He presented with a 24-week history of progressive shortness of breath and an 8-week history of recurrent syncopal attacks coupled with a significant weight loss. He had normal echocardiographic findings, however, the electrocardiogram showed features of complete heart block. Chest X-ray showed a homogeneous opacification on the right side and computed tomography scan revealed a solid right lung mass with metastases to the liver, heart, bowels, and bone. He underwent bronchoscopy, which revealed an endobronchial mass obstructing the bronchus intermedius. Histological examination of a section of lung biopsy taken during bronchoscopy confirmed the diagnosis of a small cell carcinoma. The patient underwent dual chamber pacemaker implantation with successful sinus rhythm restoration. He made an informed refusal of chemotherapy and inevitably died 18 months post pacing.
CONCLUSIONS: Despite the advancements in medical diagnostics and management, lung cancers are often diagnosed in advanced stages, with an inevitable grave prognosis. Small cell carcinoma has the potential to metastasize to the heart, resulting in complete heart block.