ATRIAL FLUTTER WITH CARDIAC TAMPONADE AS THE INITIAL MANIFESTATION OF LUNG CANCER

TOPIC: Lung Cancer TYPE: Medical Student/Resident Case Reports INTRODUCTION: Metastases to the heart and pericardium are uncommon with an incidence of 11% [1]. Symptoms include dyspnea, palpitations, arrhythmias, lower-extremity edema, chest pain. We present a rare case metastatic adenocarcinoma lung presenting as new-onset atrial flutter cardiac tamponade. CASE PRESENTATION: A 70-year-old man history COPD tobacco abuse presented worsening shortness breath for 2 weeks. On exam, he had rate 173 beats/min, blood pressure 88/58 mmHg, respiratory 40/min. He decreased sounds expiratory wheezes bilaterally. ECG showed rapid ventricular 2:1 block. received intravenous digoxin amiodarone bolus followed by infusion failure improvement rate. was placed on BiPAP distress admitted care unit. CT diffuse bilateral ground-glass opacities scattered areas nodular consolidation pleural effusions concerning malignancy. Patient underwent transesophageal echocardiography (TEE)-guided cardioversion 100 J restoration normal sinus rhythm. TEE revealed large pericardial effusion Pericardial window done symptoms. Cytology from origin. After weeks, weaned 3 L oxygen discharged home plan initiate cancer treatment. DISCUSSION: is leading cause cancer-related deaths in United States accounting 23% all [2]. It most common metastases due proximity heart. Malignant may occur occlusion lymphatic or venous drainage tumor, overproduction fluid hypoalbuminemia malignancy-associated cachexia, complication treatment including chemotherapy radiation [3]. Cytologic analysis biopsy can confirm diagnosis. Rapid accumulation Treatment options emergent pericardiocentesis window. Arrhythmias manifestation malignant only one reported our best knowledge The compression creating focus macro-reentry likely explains mechanism action case. CONCLUSIONS: which setting tamponade hemodynamic instability. Clinicians should be alert look tumors invading when patient significant risk factors presents flutter. REFERENCE #1: Chiles C, Woodard PK, Gutierrez FR, Link KM. Metastatic involvement pericardium: MR imaging. Radiographics. 2001;21(2):439-449. #2: CDCBreastCancer. An update States. Cdc.gov. Published February 24, 2021. Accessed April 30, https://www.cdc.gov/cancer/dcpc/research/update-on-cancer-deaths/index.htm #3: Suwanwongse K, Shabarek N. Atrial initial presentation caused cancer. Cureus. 2020;12(11):e11712. DISCLOSURES: No relevant relationships jehann abdallah, source=Web Response jacky duong, Qasim Jehangir, Cormack Lazarus, Yi Lee, heather wynne,