Tumors Metastatic to the Heart

A 56-year-old woman with a history of Wolff-Parkinson-White syndrome and widely metastatic ovarian carcinoma presented with new atrial fibrillation with rapid ventricular response. Her medical history was significant for high-grade serous ovarian cancer metastatic to lungs, liver, spleen, and lymph nodes.Metastasis to the heart is not as infrequent as one might suspect. Although primary cardiac tumors are rare (generally between 0.01% and 0.1% on postmortem analysis), the frequency of secondary metastatic tumors to the pericardium, myocardium, great vessels, or coronary arteries is between 0.7% and 3.5% at autopsy in the general population and up to 9.1% in patients with known malignancies.1–5 Moreover, the risk of cardiac metastasis rises with metastatic disease burden; 14.2% of patients with multiple distant metastases were found to have cardiac involvement.1 The incidence of cardiac metastases has increased over the last 30 years, perhaps attributable to increased life expectancy in oncologic patients benefitting from advances in cancer diagnosis and management.3,4Although any type of tumor can affect the heart, the probability of cardiac involvement is a function of anatomic considerations, stage of disease, and individual tumor and host biology. Primary lung cancer represents 36% to 39% of cardiac metastases, followed by breast cancer (10%–12%) and hematologic malignancies (10%–21%).1,4,6 These numbers reflect the high prevalence of these tumors in the general population and their aggressive nature; in contrast, prostate cancer, although more prevalent in men than any of the above tumors, rarely metastasizes to the heart. Pleural mesothelioma and melanoma have an unusual proclivity to involve the heart, with estimates of 28% to 56% of patients with metastatic melanoma having some cardiac involvement.1,7 Other tumors with high rates of cardiac metastasis include ovarian, gastric, renal, and pancreatic carcinomas.1,4 …