Pericardial metastases causing electrocardiographic changes: a case report.

Background: Owing to the non-specific clinical manifestations of cardiac metastases, these conditions frequently remain undetected until advanced stages, thus delaying optimal therapeutic intervention. Consequently, enhancing vigilance and the capability to identify early indicators are essential for facilitating timely diagnosis and effective management of cardiac metastases. Case summary: A 55-year-old Asian male presented with a 1-month history of intermittent abdominal distension, which had exacerbated in the preceding 2 days, accompanied by chest tightness and dyspnoea. An electrocardiogram (ECG) revealed sinus tachycardia (heart rate = 109 b.p.m.), a positive P terminal force in lead V1 (PTFV1) along with inadequate R wave progression in leads V1-V3, and partial T wave abnormalities. Cardiac colour Doppler ultrasound identified an intrapericardial mass. Subsequent investigations confirmed the diagnosis of small-cell lung carcinoma with pericardial metastasis. The patient received systemic chemotherapy with the EC regimen, completed two cycles. Follow-up ECG demonstrated sinus rhythm at a heart rate of 60 b.p.m. with some T wave changes in leads I, aVL, and V3-V6. Cardiac ultrasound indicated a significant reduction in intrapericardial lesions compared to prior findings, with concurrent improvement in symptoms of chest tightness and enhanced exercise tolerance. Discussion: Electrocardiography, particularly when showing dynamic changes, may provide clues for cardiac metastases, and its changes may demonstrate a significant correlation with pericardial metastatic tumour burden. This method potentially indicates treatment efficacy and facilitates the early detection of cardiac metastases.