Abstract 3081: Superbowl Syncope in a 21-Year-Old College Linebacker
We present a case of newly diagnosed lymphoma that presented as diffuse lymphomatous cardiac infiltration in a 21-year-old previously healthy man. Electrocardiography demonstrated Mobitz type I second-degree atrioventricular block with right-axis deviation, incomplete right bundle branch block and diffuse low voltage QRS complexes. Transthoracic echocardiogram showed marked biventricular wall thickness with heterogeneous appearance in the visceral pericardium and myocardium, normal left ventricular function and a moderate sized pericardial effusion with pre-tamponade physiology. Right heart catheterization and pericardiocentesis demonstrated effusive constrictive/restrictive physiology. Pericardial fluid cytology and lymph node biopsy were compatible with analplastic large cell lymphoma. The patient’s clinical status was deteriorating with flash pulmonary edema and worsening ventricular function and a decision to treat with anthracycline chemotherapy for potential cure had to be balanced against the potential high-risk of cardiotoxicity in a patient with ventricular dysfunction. This report will review:
the clinical manifestations of diffuse cardiac lymphoma, including electrocardiography, echocardiography, and right heart catheterization results;
pathophysiology, including explanations for the development of arrhythmia, pulmonary edema, endomyocardial microvas-cular infarcts, serum troponin rise, and effusive constrictive/restrictive cardiomyopathy;
pathology and imaging findings, including a discussion of the utility of cardiac MRI and myocardial biopsy in the diagnosis of cardiac lymphoma and the need to maintain a high index of suspicion in light of non-diagnostic results;
the therapeutic approach for the use of anthracycline chemotherapy, as well as angiotensin-converting enzyme inhibitor and beta-blocker therapy for cardioprotection in this setting; and
follow-up of the patient’s clinical status.