Chest Pain and ST-Segment Elevation

Primary cardiac angiosarcomas are rare malignant tumors that can cause chest pain and heart failure symptoms. They can be diagnosed using multimodality imaging, primarily echocardiogram, with formal diagnosis requiring biopsy. A 56-year-old man with history of hypertension and dyslipidemia presented with acute crushing chest pain and shortness of breath. Electrocardiogram showed diffuse ST-segment elevations. Urgent coronary angiography revealed no significant coronary disease but found delayed contrast filling from the left coronary artery to a structure overlying the right atrium with further work-up revealing primary cardiac angiosarcoma. This case represents a unique scenario in which primary cardiac angiosarcoma was discovered from coronary angiography. Clinicians should prioritize and rule out life-threatening emergencies but should recognize the utility of angiography in elucidating other etiologies of chest pain (eg, angiosarcoma). Finally, early screening for metastatic disease should be completed to identify alternative potential biopsy targets.