Acute coronary syndrome as a rare manifestation of melanoma with cardiac metastasis: a case report

Introduction. Clinical manifestations of cardiac tumors are nonspecific and can be similar to various cardiovascular diseases. One of the most common sources of secondary cardiac tumors is melanoma. Diagnosis of melanoma with cardiac metastasis is difficult due to the predominantly asymptomatic course.

Case description. A case report describes a rare clinical manifestation of melanoma under the guise of acute myocardial infarction in a 51-year-old patient who underwent excision of upper limb melanoma, lymphadenectomy and immunotherapy 5 years ago. The patient was prescribed combination immunotherapy with nivolumab and ipilimumab. Control examination (cardiac magnetic resonance imaging, combined positron emission-computed tomography) after 3 months demonstrated significant regression of the size and metabolic activity of tumor foci both in the heart and in other organs.

Discussion. Despite the predominantly asymptomatic course, cardiac metastasis of melanoma can manifest with chest pain, ischemic abnormalities in the ECG and increased cardiac biomarkers, which creates a picture of acute coronary syndrome. The presented case demonstrates the high efficiency of combination immunotherapy in achieving regression of melanoma metastases in the heart and other organs.

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