P31 A RARE CASE OF PERSISTENT ECG CHANGES AT STRESS TEST

Abstract

Abstract Background Cardiac lipomas are rare benign tumors. They carry usually a good prognosis and are often an incidental finding of cardiovascular imaging exams for cardiac evaluations. Methods We present a case of left ventricular intramyocardial lipoma detected during the work–up for a positive stress test. Results This case report involves a 55–year–old male, light smoker, with a history of glucose intolerance. Height 190 cm; weight 90 kg; BMI 24.93 kg/m2 He has always played sports and since the age of 16 he performed serial cardiological assessments and stress test for competitive fitness. Already from the first evaluation the ergometric test was markedly pathological (ST segment depression greater than 1 mm in leads V3 to V6), in absence of symptoms. The subsequent diagnostic exams performed (including an exercise myocardial scintigraphy) excluded ischemic aetiology. Competitive fitness has always been reconfirmed for many years. He also performed repeated holter–ECG in absence of any arrhythmias. He was admitted because of a routine check–up. A new stress test (ECG stress test) resulted positive for ECG changes and clinically negative (fig 1) Cardiac MRI demonstrated a small intramyocardial "round like" mass of about 7 mm, located on the middle–distal segment of the left ventricle lateral wall; MRI signals were consistent with a lipom: no evidenced of delayed enanchement (fig 2) and T1 weighted scans assessed perfusion lack of the mass (fig 3). Computed tomography confirmed this diagnosis; the coronary angiography excluded significant coronary artery stenosis. Conclusion We hypnotize that cardiac lipoma in our patient caused persistent ST changes at stress ECG since young age