Chest Pain: Walking through a Common Symptom

摘要

A 35-year-old man presented with persistent chest pain. The patient had no known cardiovascular risk factors and an uneventful physical examination. The electrocardiogram showed a biphasic T wave in precordial leads. His echocardiogram revealed an echogenic mass of irregular appearance in the ventricular apex. A more detailed patient interview uncovered a past history of a skin lump. We continued our investigation with thoracic computed tomography and nuclear magnetic resonance, followed by cardiac biopsy that established the diagnosis of cardiac metastasis of a previous skin melanoma. His hospitalization complicated with intense and persistent chest pain refractory to treatment with conventional analgesics, nonsteroidal anti-inflammatory drugs and colchicine. Merely, adjuvant corticosteroid was able to control the incapacitating pain, although for a short period of time. This case illustrates a common symptom associated with a dismal cause, where time to diagnosis his critical and treatment of patient’s symptoms is sometimes challenging.