ICI-Induced Myocarditis: When Chest Pain Isn’t a Blocked Vessel | Case Study Samuel Zeng, MD - MOASC

ARTICLE: https://oncologytube.com/ici-induced-myocarditis-when-chest-pain-isnt-what-it-seems/

In this video, Samuel Zeng, MD, a second-year internal medicine resident at UCLA, presents a compelling case study titled "ICI-Induced Myocarditis: When Chest Pain Is Not Due to a Blocked Vessel." Dr. Zeng explores a rare and lethal complication of immune checkpoint inhibitors (ICIs) in an 84-year-old patient with a strong cardiac history and stage III non-small cell lung cancer. Learn how chest pain in patients on ICIs can indicate more than just cardiac issues, the critical need for an expanded differential diagnosis, and key clinical takeaways.

Timestamps below guide you through the case, from initial presentation to the final diagnosis of triple M syndrome (myocarditis, myositis, and myasthenia gravis). Don’t forget to like, subscribe, and share your thoughts in the comments!

Presented by Samuel Zeng, MD - UCLA

Timestamps:
0:00 - Introduction
Samuel Zeng, MD - UCLA, introduces himself and the topic of ICI-induced myocarditis.
0:08 - Poster Title and Objective
Dr. Zeng presents the poster: "ICI-Induced Myocarditis: When Chest Pain Is Not Due to a Blocked Vessel" and outlines the goal to expand differential diagnoses in patients on immune checkpoint inhibitors.
0:33 - Patient Background
Dr. Zeng introduces the 84-year-old patient with stage III non-small cell lung cancer, started on durvalumab, and her significant cardiac history (8 stents).
0:55 - Initial Presentation
The patient presents with chest pain three weeks after starting durvalumab; initial workup shows elevated troponin but no EKG changes.
1:07 - Cardiology Workup
Cardiology performs a left heart catheterization, finds a partial blockage, but stenting doesn’t resolve the chest pain.
1:24 - Escalating Symptoms
The patient develops a second-degree heart block, progressing to a complete heart block, requiring a pacemaker.
1:39 - A Puzzling Case
Dr. Zeng discusses the unusual chest pain and the involvement of a multidisciplinary team, still suspecting acute coronary syndrome (ACS).
2:03 - New Symptoms Emerge
On day 12, the patient develops myasthenia gravis-like symptoms (droopy eye, shoulder weakness, worsening breathing).
2:14 - Final Diagnosis: Triple M Syndrome
Neurology consultation reveals triple M syndrome (myocarditis, myositis, myasthenia gravis) as a rare ICI complication.
2:42 - Outcome and Takeaway
Dr. Zeng notes the late diagnosis leading to the patient’s passing; emphasizes considering ICI-related complications in patients with cardiac history.
3:20 - Guidelines and Recommendations
Dr. Zeng discusses ASCO guidelines, the role of early prednisone, and additional tests like CK to differentiate myositis from ACS.
4:05 - Subtle Clues and Lessons
Elevated transaminases suggest ICI-related hepatitis; Dr. Zeng reflects on how standard ACS workups may miss ICI complications.