Most common site of cardiac metastasis – Cardiology MCQ – Answer
Most common site of cardiac metastasis – Correct answer: a) Pericardium
More than 60% of the metastatic involvement of heart is in the pericardium . This can cause pericarditis or effusion. In fact, the commonest cause of cardiac tamponade is malignant pericardial effusion, which is most often due to metastasis.
Myocardial metastasis may occur in one third of cases. These can present with cardiac arrhythmia or chest pain which can sometimes mimic acute coronary syndrome. If there is extensive myocardial involvement ventricular force of contraction may be affected, leading to heart failure. Rarely even myocardial rupture can occur.
Endocardial involvement is the least common and seen in 3-5% cases. It can cause tumour emboli or obstruction of valves.
Radiofrequency catheter ablation of electrical storm resulting from metastatic cardiac tumour has also been described . There were episodes of sustained ventricular tachycardia and ventricular fibrillation. Multiple ablations were required to make the arrhythmia non inducible.
Maleszewski JJ, Bois MC, Bois JP, Young PM, Stulak JM, Klarich KW. Neoplasia and the Heart: Pathological Review of Effects With Clinical and Radiological Correlation. J Am Coll Cardiol. 2018 Jul 10;72(2):202-227.