Introduction Typical angina pain characterised by central chest pain, which is associated with autonomic symptoms, is commonly associated with acute coronary syndrome (ACS). However, a detailed clinical examination should be done to exclude other differential diagnoses. Herein, we report a case of a patient diagnosed with ACS who was later found to have a primary cardiac tumour.

Case Presentation A 63-year-old woman with hypertension and spondylosis presented with central chest pain radiating to her back and right shoulder, associated with perioral numbness and breathing difficulty. Examination revealed blood pressure of 156/99 mmHg, pulse rate of 93 bpm, and respiratory rate of 22 breaths per minute, but no hypoxia. ECG showed right bundle branch block, premature ventricular contractions, and Q waves in leads III and AVF. Chest X-ray and cardiac enzymes were normal. She was diagnosed with unstable angina and treated with dual antiplatelet therapy and anticoagulants. Transthoracic echocardiography revealed a mass in the interventricular septum with good left ventricular function, while coronary angiography showed mild coronary artery disease. CT coronary angiography revealed no significant atherosclerosis but identified a right ventricular mass, likely a lipoma. Cardiac MRI confirmed a basal-mid anteroseptal mass, measuring 1.54 cm × 1.57 cm × 2.18 cm, likely a primary tumour. She is not keen on invasive surgery and is currently under regular transthoracic echocardiography follow-up.

Discussion Cardiac tumours are a rare but important cause of chest pain, often mimicking more common conditions such as acute coronary syndrome. In this case, the patient initially presented with chest pain radiating to the back and shoulder, which raised suspicion for coronary ischemia. Cardiac tumours can induce chest pain through direct compression of myocardial structures, leading to impaired coronary blood flow and ischaemia, or by interfering with the mechanical function of the heart, causing angina-like symptoms. Previous case reports have similarly described chest pain from cardiac tumours due to obstruction, compression, or infiltration of myocardial tissue. The diagnosis in such cases relies on advanced imaging modalities like cardiac MRI, which provides detailed characterisation of the mass. Small, benign tumours generally have a good prognosis with conservative management, whereas malignant tumours require aggressive interventions, including complete surgical resection and adjuvant chemotherapy.

Conclusion This case illustrates the challenge of diagnosing central chest pain when initial treatment addresses acute coronary syndrome, but other diagnoses must still be considered. Primary cardiac tumours are rare and require advanced imaging for an accurate diagnosis. Timely detection and intervention are crucial for effective patient management and prognosis.