key: cord-0785361-dozq6cv5
authors: Torosyan, Nare; Gonzalez Mancera, Miguel S.; Tourtellotte, Warren G.; Kedan, Ilan
title: Leukemic Infiltration of Myocardium Presenting as Cardiac Arrest
date: 2021-06-16
journal: JACC Case Rep
DOI: 10.1016/j.jaccas.2021.01.033
sha: 65c3eb70e1b648bdda51bc27d2e50028a6ea3738
doc_id: 785361
cord_uid: dozq6cv5

Clinically significant myocardial infiltration by leukemic cells is a rare phenomenon. We describe a case of a 47-year-old woman with newly diagnosed acute myeloid leukemia and pleuritic chest pain with rapid cardiopulmonary decompensation. Post-mortem analyses showed fibrinous pericarditis and extensive leukemic infiltration of the myocardium. (Level of Difficulty: Intermediate.)

Past medical history was notable for mild intermittent asthma. Surgical history was significant for donor nephrectomy.

The patient's presentation was concerning for several possibilities, including acute pulmonary embolism, acute heart failure, cardiac tamponade, or

To identify leukemic cardiac infiltration as a potential cause of myocardial injury in patients with acute leukemia.

To recognize cardiac manifestations of acute leukemia.

To understand the pathogenesis of cardiac dysfunction associated with acute leukemia.

pneumonia. In the context of acute leukemia, leukostasis and severe anemia were also considered.

Initial laboratory evaluation revealed a white blood cell count of 138 (1,000 U/l) with 55% circulating blasts, hemoglobin level of 5.5 g/dl, and platelets of 87 (1,000 U/l) ( Post-mortem gross examination of the heart was remarkable for fibrinous pericarditis, as demonstrated by replacement of the normally smooth pericardium with shaggy, granular exudate

There is evidence of sinus tachycardia with low QRS voltages but no ST-or PR-segment changes. were found before therapy and a majority were asymptomatic and only trivial in size (5) . Cardiac tamponade was found in 3% of patients in this cohort.

Proposed mechanisms for pericardial disease include leukemic infiltration, increased susceptibility to bleeding due to thrombocytopenia, and increased risk of infection due to an immunocompromised state (6) .

Conduction defects due to leukemic involvement may also manifest with cardiac arrhythmias.

There are no established guidelines specific to cardiovascular complications associated with acute leukemia. In general, the management of cardiovascular disease is the same as for patients without leukemia. As exemplified by this case, patients can have rapid decompensation due to cardiac involvement.

Understanding the underlying pathophysiology and recognizing potential cardiac manifestations can aid in timely diagnosis, assessment, and treatment of patients with acute leukemia.

Autopsy findings, as described, revealed that the patient died of cardiac arrest potentially accelerated by Repeat study demonstrates an increase in the size of pericardial effusion.

The epicardial surface of the heart shows a shaggy, granular exudate consistent with fibrinous pericarditis. 

Acute myeloid leukemia: a comprehensive review and 2016 update

Leukemic ischemia: a case of myocardial infarction secondary to leukemic cardiac involvement

Acute myeloid leukaemia as a cause of acute ischaemic heart disease

Acute leukemia is associated with cardiac alterations before chemotherapy

Characteristics of pericardial effusions in patients with leukemia

Acute myeloid leukemia presenting as effusive constrictive pericarditis