Case Report

Complete Heart Block and Cardiac Tamponade Secondary to Merkel Cell Carcinoma Cardiac Metastases

Authors: Capt. Maria Conley, USAF, MC MAJ, Karin Hawkins, USAF, MC LT COL, David Ririe, USAF, MC

Abstract

Abstract:This is a unique case of Merkel cell carcinoma, a rare neuroendocrine tumor, metastasizing to the heart and inducing a progression of cardiac complications such as new-onset atrial fibrillation, malignant pericardial effusion with tamponade physiology, first-degree heart block, and complete heart block. Metastases to the heart are relatively rare but should be suspected if a patient with a known neoplasm presents with new cardiac manifestations. This is the first case report of cardiac metastases from Merkel cell carcinoma causing cardiac tamponade or complete heart block. This case highlights the clinical decision-making involved in managing cardiac tamponade and complete heart block in the setting of metastatic disease to the heart.

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References

1. Jongbloed MRM, Kanen BLJ, Visser M, et al. Intracardiac metastasis from a Merkel cell carcinoma.J Clin Oncol 2004;22:1153–1156.
 
2. Goessling W, McKee PH, Mayer RJ. Merkel cell carcinoma. J Clin Oncol 2002;20:588–598.
 
3. Yamana N, Sueyama H, Hamada M. Cardiac metastasis from Merkel cell skin carcinoma. Int J Clin Oncol 2004;9:210–212.
 
4. Chao TC, Park JM, Rhee H, et al. Merkel cell tumor of the back detected during pregnancy. Plast Reconstr Surg 1990;86:347–351.
 
5. Page E, Fric D, Barjhoux JL, et al. Cardiac metastasis from a Merkel cell skin carcinoma: A case report. Arch Mal Coeur Vaiss 2001;94:1423–1426.
 
6. Sarjeant JM, Butany J, Cusimano RJ. Cancer of the heart. Am J Cardiovasc Drugs 2003;3:407–421.
 
7. Roberts WC. Primary and secondary neoplasms of the heart. Am J Cardiol 1997;80:671–682.
 
8. Hall RJ, Cooley DA, McAllister HA Jr, et al. Neoplastic heart disease. In Fuster V, Alexander RW, O'Rourke RA, et al. (eds): Hurst's The Heart, 11th ed, New York, McGraw-Hill, 2004, pp. 2081–2096.
 
9. Salcedo EE, Cohen GI, White RD, et al. Cardiac tumors: diagnosis and management. Curr Probl Cardiol 1992;17:79–131.
 
10. Spodick DH. Acute cardiac tamponade. N Engl J Med 2003;349:684–690.
 
11. Hoit BD, Faul MD. Diseases of the pericardium. In Fuster V, Alexander RW, O'Rourke RA, et al. (eds): Hurst's The Heart, 11th ed, New York: McGraw-Hill, 2004, pp. 1985–1988.
 
12. Vaitkus PT, Herman HC, LeWinter MM, Treatment of malignant pericardial effusion. JAMA1994;272:59–64.
 
13. Laham RJ, Cohen DJ, Kuntz RE, et al. Pericardial effusion in patients with cancer: outcome with contemporary management strategies. Heart 1996;75:67–71.
 
14. Allen KB, Faber LP, Warren WH, et al. Pericardial effusion: subxiphoid pericardiostomy versus percutaneous catheter drainage. Ann Thorac Surg 1996;67:437–440.
 
15. Gregoratoros G, Abrams J, Epstein AE, et al. ACC/AHA/NASPE 2002 guideline update for the implantation of cardiac pacemakers and antiarrhythmia devices: summary article: a report of the ACC/AHA Task Force on practice guidelines (ACC/AHA/NASPE Committee to Update the 1998 Pacemaker Guidelines) Circulation 2002;106:2145–2161.
 
16. Sparano J, Ramirez M, Wiernik PH. Increasing recognition of corticosteroid-induced tumor lysis syndrome in non-Hodgkin's lymphoma. Cancer 1990;65:1072–1073.
 
17. Habib GS, Saliba WR. Tumor lysis syndrome after hydrocortisone treatment in metastatic melanoma: a case report and review of the literature. Am J Med Sci 2002;323:155–157.