Cardiac malignancies Flashcards
What is the most common neoplasm in the heart?
Metastases account for 75% of cardiac neoplasms.
What are the most common cancers that lead to metastases to the heart?
The heart’s most common metastatic sites include melanoma, lung, breast, soft-tissue, and leukemia/lymphoma.
What is the most common primary cardiac tumor?
Left atrial myxoma is the most common primary cardiac tumor, often arising from the atrial septum as a pedunculated, friable mass. Histologically, these tumors demonstrate scattered myxoma cells within a mucopolysaccharide stroma and blood vessels, which may be encircled by myxoma cells. Myxomas produce a large amount of vascular endothelial growth factor, which contributes to the angiogenesis, hemorrhaging (seen as brown hemosiderin deposits), and friability characterizing these tumors.
What is the classic auscultatory finding associated with left atrial myxoma?
A low-pitched diastolic murmur over the cardiac apex, sometimes with a ‘tumor plop’ sound, due to obstruction of the mitral valve. Occasionally when patients change positions while being auscultated the murmur will subside indicating it’s maneuverability.
Where do myxomas tend to arise?
80% in the left atria.
What are the classic symptoms of left atrial myxoma?
Symptoms include cardiovascular findings (chest pain, dyspnea, palpitations), symptoms of heart failure, possible arrhythmias, embolization (stroke, arterial occlusion), and constitutional symptoms (fever, weight loss). Left atrial myxomas frequently obstruct blood flow from the left atrium to the left ventricle, leading to a murmur mimicking that of mitral stenosis (ie, mid-diastolic rumble at the apex). The obstruction can also lead to a decrease in cardiac output that manifests as dyspnea, lightheadedness, or syncope. Because the mass is typically mobile, obstructive symptoms may be transient and influenced by position (ie, upright posture exacerbates mitral obstruction, whereas lying down alleviates it). In some patients, fragments of the mass may embolize into the systemic circulation (eg, resulting in stroke or acute limb ischemia). In addition, some myxomas can produce cytokines (eg, interleukin-6) that lead to constitutional symptoms including fever and weight loss.
How is left atrial myxoma diagnosed?
Diagnosed by echocardiography, with transesophageal echocardiography (TEE) being more sensitive than transthoracic echocardiography (TTE).
What is the treatment for left atrial myxoma?
Surgical resection is the definitive treatment to prevent embolization and hemodynamic complications.
How do left atrial myxomas lead to arterial embolization?
The tumors are friable and can shed emboli into systemic circulation, causing acute arterial occlusion (e.g., stroke, limb ischemia).
What clinical findings suggest acute limb ischemia due to embolization?
Acute-onset pain, diminished pulses, paleness, cool extremity, and intact sensation in the affected limb.
What are other possible sources of embolization leading to acute limb ischemia?
Malignancies like pancreatic cancer, coagulopathies such as Factor V Leiden heterozygosity, cardiac arrhythmias like atrial fibrillation or severe ventricular dysfunction secondary to a heart aneurysm following in MI, endocarditis, non-bacterial thrombotic endocarditis, valvular disease, or prosthetic valves.
What abnormality is associated with benign valvular growth that can lead to an embolus (TIA/stroke)?
Papillary fibroelastoma.
What are the primary vascular malignancies?
Angiosarcoma, which typically occurs in the head, neck, and breast areas, often in elderly patients, and is associated with radiation therapy or chronic postmastectomy lymphedema.
What cardiac tumor is commonly found in children?
Rhabdomyomas, which are strongly associated with tuberous sclerosis and occur almost exclusively in children.
What is non-bacterial thrombotic endocarditis (NBTE) also known as?
NBTE is also called marantic endocarditis or Libman-Sacks endocarditis (when associated with systemic lupus erythematosus - SLE).
