An unusual cause of STEMI and cardiac tamponade.

To cite: Esfahani K. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2014206926 DESCRIPTION A 28-year-old patient with refractory mediastinal B-cell lymphoma presented with acute onset of chest pain and shortness of breath. On clinical examination, the Beck triad of hypotension, distant heart sounds and elevated JVP was demonstrated. Furthermore, the patient was tachycardic and had a pulsus paradoxus of 20 mm Hg. A bedside ECG (figure 1B) demonstrated diffuse low voltages and acute ST elevation in the anterolateral leads, different from the patient’s baseline (figure 1A). These findings, in conjunction with the clinical examination, were worrisome for acute cardiac tamponade and ST elevation myocardial infarction (STEMI). An infused CTof the chest demonstrated new masslike pericardial involvement of the heart from the previously known mediastinal lymphoma, without any associated pericardial effusion (figure 2). Involvement of the left heart explained the patient’s STelevation in the anterolateral leads, while involvement of the right heart explained the patient’s clinical symptoms of tamponade. The patient passed away shortly after hospital presentation. Acute STEMI is a very rare complication of malignancy. Myocardial infarction in the setting of invasive malignancy is thought to be due to a combination of ischaemic infarction, altered oxygen consumption and tumour embolisation of coronary arteries. 2