Abstract 13132: Evolving Heart Block treated With a CHOP
Introduction: Primary cardiac lymphoma (PCL) is a very rare disorder accounting for less than 1% of all lymphomas. Presenting symptoms may be chest pain, congestive heart failure, pericardial effusions and arrhythmias. Herein, we present the case of a 62- year-old immunocompetent female with a one week history of worsening endurance and Wenckebach heart block who was ultimately diagnosed with primary cardiac lymphoma.
Case: A 62-year-old woman was admitted with dyspnea, fatigue and bilateral pitting edema for 1 week. She was bradycardic with a heart rate of 55. Clinical examination was otherwise unremarkable. Electrocardiogram demonstrated Mobitz I second degree AV block. Echocardiography subsequently revealed a right atrial and ventricular mass. CT angiography of the chest demonstrated a 4-5 centimeter filling defect surfacing from the posterior right atrial and ventricular wall. She subsequently developed complete AV block with runs of ventricular tachycardia during her hospitalization requiring biventricular pacemaker implantation with automatic defibrillator. Excisional biopsy revealed diffuse large B-cell lymphoma. Patient underwent 6 cycles of rituximab, cyclophosphamide, adriamycin, vincristine and prednisone (R-CHOP) and achieved complete remission.
Discussion: PCL often presents with non-specific symptoms that vary depending on the locations in the myocardium. The most common clinical manifestations are pericardial effusion, AV block and heart failure being the most common cause of death. Imaging studies are essential in estimating the extent of disease. However, surgical intervention is needed to confirm the diagnosis histologically. Fortunately, early treatment with R-CHOP can lead to remission. This case represents a fascinating presentation of a very rare malignancy.
Author Disclosures: R.K. Zein: None. J.A. Mouabbi: None. M. Inany: None. T. Hadid: None. T. Lalonde: None.
- © 2016 by American Heart Association, Inc.