Heart Palpitations Lung Cancer – Author: Ankit Agrawal, MD Resident Physician, Saint Peter’s University Hospital / Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
Harikrishna Bandla, MD Resident Physician, Saint Peter’s University Hospital / Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
Heart Palpitations Lung Cancer
A 52-year-old man was presented to the emergency department (ED) with acute concern of sudden chest pain, shortness of breath, and palpitations.
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History. The man had a history of stage IV non-small cell lung cancer (NSCLC) that was treated with radiotherapy and partial resection of the lower lobe of the lung; brain metastases to the right occipital lobe and left parietal lobe treated with craniotomy followed by removal of the metastatic tumor and whole brain radiotherapy; epilepsy after metastasis; and coronary artery disease in the past drug addiction. He had a smoking history of 25 packs a year.
Physical examination. The patient’s blood pressure was 127/61 mmHg in the right arm and 125/58 mmHg in the left, heart rate was 102 beats/minute, respiration rate was 20 breaths/minute, temperature was 36.6°C and oxygen saturation was 95. %. on the air. A thorough physical examination revealed S1 and S2 heart sounds.
The patient’s history of cancer and a strong suspicion of pulmonary embolism led to a computed tomography (CT) pulmonary angiography, the results of which revealed a massive tumor in the right middle lobe (Figure 2). A mild to moderate pericardial effusion was also noted (Figure 3).
The patient began a regimen of subcutaneous enoxaparin, 1 mg/kg twice a day, as a treatment for pulmonary embolism. They were comfortable overnight in the hospital. However, the next morning, he said that his chest was very painful. Blood pressure at this time was 90/55 mm Hg in the right arm and 87/57 mm Hg in the left. High arterial pressure and muffled heart sounds were noted.
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An early diagnosis of cardiac tamponade at the patient’s bedside was made, confirmed by rapid echocardiography, the results of which showed hemodynamically significant pericardial effusion and diastolic right ventricular collapse (Figure 4).
Education in the hospital. The patient was given an intravenous bolus, which resulted in hemodynamic improvement. An abdominal CT-guided biopsy was immediately performed, during which 300mL of septic fluid was aspirated and cardiac drainage was left. He also reported a significant improvement in chest pain after the procedure. Subsequent pericardial fluid analysis revealed the presence of metastatic adenocarcinoma.
Due to the high involvement of recurrent pericardial effusion, the patient underwent a pericardial window and pericardial biopsy, the results of which also showed metastatic adenocarcinoma.
The result of the case. The patient had no postoperative complications and was stable at follow-up, with minimal recurrence of pericardial effusion.
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Conversations. The pericardium is a fibroelastic sac that covers the heart. It consists of a parietal and visceral layer, and the space between them, the pericardial space, usually contains a thin layer of less than 50ml of plasma ultrafiltrate called pericardial fluid. Cardiac tamponade is a pericardial compression syndrome caused by the accumulation of pericardial fluid. It is a life-threatening accident. It can happen suddenly, profoundly, or magically. Cancer-related pericardial disease that causes tamponade is more severe and is usually caused by heart disease (eg, lung cancer, breast cancer, lymphoma) rather than heart tumors. Dyspnea is the most common symptom of cardiac tamponade and is sometimes a symptom of cancer.
Cardiac tamponade is known as Beck’s triad: hypotension, dilated jugular veins, and muffled heart tones. As part of the diagnosis, the chest X-ray shows the size of the heart, 3 and the ECG often shows a decrease in electrical activity and changes in electrical activity. may be high but not have future benefits.6
Convulsions of the right atrium at the end of diastole and the right ventricle at the beginning of diastole are characteristic of echocardiography and show an intrapericardial pressure that exceeds the intracardiac pressure during diastole. in the presence of explosive tamponade. 7 Our patient had evidence of ventricular diastolic collapse (Figure 3), which is less common but more common than tamponade.
Acute tamponade usually occurs as a result of cardiac trauma or rupture of the heart or as a complication of diagnostic or therapeutic procedures such as cardiac catheterization. Subacute tamponade usually results from an idiopathic neoplasm or pericarditis. Malignancy accounts for 32% of cardiac tamponade cases, the 8th most common of which is lung cancer, while NSCLC accounts for 5% of cases.
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Catheter drainage is the most common treatment option. The indwelling catheter is usually left in place until the fluid is reduced to 20-30 ml/day. Surgical damage, and the formation of a pericardial window, can be possible when there is an increased chance of recurrence of pericardial effusion so that fluid enters the pleural or peritoneal cavity. Recurrent negative discharge can exceed 90% 10 and is a poor diagnosis. For these patients, the main goal should be informational treatment aimed at improving quality of life.9 “Do not doubt that a small group of caring and committed citizens can change the world. In fact, it is the only thing that has not been done”. Margaret Mead
He cites this article as: Haq S, Roomi S, Lashari B H, et al. (November 07, 2019) Chronic ventricular tachycardia as a symptom of lung cancer. 11 (11): e6090. doi: 10.7759/.6090
The leading cause of death from cancer in the United States is lung cancer. They can be divided into small lung cancer and non-small cell lung cancer. Finally, adenocarcinoma includes most lung cancers. The manifestations of lung cancer can be divided into thoracic, extrathoracic and paraneoplastic syndromes. We report a case of ventricular tachycardia in a patient who suffered from dysphagia, who was eventually diagnosed with non-small cell lung cancer invading the esophagus and heart.
Lung and bronchial cancer are the leading causes of death in the United States and worldwide [1-2]. According to the SEER cancer statistics analysis, in the United States the number of lung and bronchial cancers in 2018 was about 234,030 and the number of deaths was about 154,050. The 5-year survival rate was 18.6% [1].
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Lung cancer can be divided into two groups that include approximately 90% of all lung cancers, small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC) [3 ]. NSCLC includes adenocarcinoma, which is the most common type and accounts for about 40% of all lung cancers. Squamous cell carcinoma accounts for about 25%-30% and large cell carcinoma accounts for about 5%-10%. One of the leading causes of lung cancer is smoking [4], but it can occur without a history of smoking. Other risk factors that have been studied to cause lung cancer are tobacco smoke, radon gas, exposure to asbestos, air pollution, personal and family history and the association of genes such as TP53 [5].
The manifestations of lung cancer can be divided into thoracic and extrathoracic manifestations and paraneoplastic syndromes. Thoracic manifestations may include a variety of signs and symptoms. It can cause coughing in more than 50% of patients with sputum. Throats can also be scratched with blood representing hemoptysis [6]. Lung cancer can also involve recurrent laryngeal nerves that can cause heartburn. Other local symptoms may include invasion of the esophagus leading to dysphagia and spread to the heart which may cause pericardial effusions and arrhythmias [7].
We report a case of ventricular tachycardia as a manifestation of lung cancer in a patient who initially had dysphagia but was diagnosed with NSCLC that invaded the esophagus and heart along with local migration.
Our patient is an 83-year-old woman with a medical history of hypertension and a recent history of dysphagia who presented to the hospital with a gradual increase in dysphagia, especially on solids. The patient reported that he had weighed about 70 pounds the previous year before coming to the hospital and was checked out at another hospital because of illness. For each patient, they had been seen in the previous hospital about a month ago and the gastrointestinal endoscopy was normal. Previously, the patient had radiographic findings suggestive of achalasia and esophageal manometry was expected. Other symptoms such as odynophagia, nausea, vomiting, bowel changes, melaena, bright red blood in the rectum were absent. Family history did not contribute to any disease.
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The initial chest X-ray was unrevealing. A complete metabolic panel revealed normal electrolytes and LFTs. A complete blood count showed anemia with a hemoglobin of 11.4 and a hematocrit of 33.3.
It was evaluated by GI and esophageal manometry was performed. He showed evidence of achalasia (subtype II) and then esophagogastroduodenoscopy (EGD) with balloon dilation was performed and Botox injection was successfully used to relax the sphincter. This did not alleviate his symptoms of dysphagia and total parenteral nutrition was started to help.
The possibility of external obstruction was to be followed and a computed tomography (CT) of the chest was performed. It revealed a mass of soft tissue just behind the heart
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