Cardiac metastases

Background

• Malignancies in the heart are much more commonly metastatic rather than primary
• Sites of metastasis include:
  • Pericardium (most common, 65% of cardiac metastases)
  • Epicardial (30%)
  • Myocardial (30%)
  • Endocardial and intracavitary (rare, 3-5%)

Clinical Manifestations

Site of Metastasis	Manifestations
Pericardial	Pericarditis, pericardial effusion, cardiac tamponade Pericardial adhesions and constrictive pericarditis
Epicardial and myocardial	Atrial and ventricular arrhythmias and conduction abnormalities, including atrial fibrillation/flutter, AV block, PVCs, and ventricular fibrillation Heart failure Myocardial ischemia/infarction from coronary artery compression, tumour embolism, or coronary invasion Cardiac rupture
Endocardial and intracavitary	Obstruction, heart failure, cardiogenic shock Pulmonary tumour embolism Stroke from tumour embolism
Superior/inferior vena cava	Superior vena cava syndrome Inferior vena cava syndrome Right heart metastasis

Further Reading

• Goldberg AD, Blankstein R, Padera RF. Tumors metastatic to the heart. Circulation. 2013 Oct 15;128(16):1790-4. doi: 10.1161/CIRCULATIONAHA.112.000790. PMID: 24126323.