Abstract
Metastatic tumors of the heart presenting with complete heart block (CHB) is an extremely uncommon case. There are no available guidelines in managing CHB in terminal cancer. Permanent pacemaker implantation in such cases is a challenge in terms of clinical utility and palliative care. We report a case of a 24-year-old man suffering from tongue cancer presenting with CHB. An intracardiac mass and moderate pericardial effusion were present, presumed as the metastatic tumor of tongue cancer. We implanted a temporary pacemaker for his symptomatic heart block and cardiogenic shock, and pericardiocentesis for his massive pericardial effusion. We decided that a permanent pacemaker would not be implanted based on the low survival rate and significant comorbidities. Multiple studies report a variable number of cardiac metastasis incidence ranging from 2.3% to 18.3%. It is rare for such malignancies to present with CHB. The decision to implant a permanent pacemaker is highly specific based on the risks and benefits of each patient. It needs to be tailored to the patient’s functional status, comorbid diseases, prognosis, and response to conservative management.
Highlights
Metastatic tumors of the heart presenting with complete heart block (CHB) is an extremely uncommon case
We report a case of CHB caused by cardiac metastasis and review the literature to further help the management of our patient
We acquired 14 cases reporting CHB as a manifestation of cardiac metastasis originating from various malignancies, three of which are from the oral cavity
Summary
Any further responses from the reviewers can be found at the end of the article Introduction Cardiac metastasis is the least common presentation in malignant cancer. We report a case of CHB caused by cardiac metastasis and review the literature to further help the management of our patient. The patient was presented with chest discomfort and general weakness. He was hypotensive and bradycardic with a blood pressure of 80/40 mmHg, regular heart rate of 44 beats per minute, respiratory rate of 18 breaths per minute, and oxygen saturation of 97% on room air. After general supportive treatment, including intravenous dopamine administration, electrolyte imbalance correction, supportive treatment of general weakness condition, anemia, hypoalbuminemia, and infection, the patient showed improvement in general condition.
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