Chest Pain in a Man With Testicular cancer

BACKGROUND This 26-year-old man has mixed germ cell tumor (testicular cancer) with metastasis to the lungs. One year prior to his admission, stage I testicular cancer was diagnosed. The patient underwent right orchiectomy. Pathology revealed mixed germ cell tumor. After surgery his levels of the tumor marker alpha-fetoprotein were normal. The cancer was in remission, but then follow-up CT scans showed multiple lung adenopathies and pulmonary nodules. His alpha-fetoprotein levels also became elevated. The patient denies having a history of coronary artery disease and is not taking any medications. He denies alcohol or drug abuse. He has smoked half a pack of cigarettes per day for 9 years. He had no significant adverse effects after his first dose of chemotherapy with cisplatin, bleomycin, and etoposide. On day 8, he received another dose of bleomycin without any adverse event; however, he presented to the emergency department 36 hours later because of severe, crushing chest pain accompanied by shortness of breath and diaphoresis. Figure 1 shows his ECG, and Figure 2 shows an image obtained during cardiac catheterization. Hint Focus on the patient's medications and chest pain. Author: Jane T. Tan, RN, and Winston W. Tan, MD, FACP, Assistant Professor, Department of Medicine, Division of Hematology Oncology, Mayo Clinic Jacksonville Division of Emergency Medicine, Evanston Northwestern Healthcare eMedicine Editor: John Vozenilek, MD Division of Emergency Medicine, Evanston Northwestern Healthcare