Cardiac Masses Flashcards
How do you diagnose endocarditis?
Definitive = 2 major; 1 major + 3 minor; 5 minor
Possible = 1 major + 1 minor; 3 minor
What is considered MAJOR?
- Positive blood culture
- Evidence of endocardial involvement by echo or new murmur
What is considered MINOR?
- Predisposing heart condition or IV drug use
- Fever > 38 C (100.4 F)
- Vascular Phenomena
- Immunologic Phenomena
- Suspect blood culture
What are SIGNS/SYMPTOMS of endocarditis?
- Can be acute or subacute (more gradual)
- Flu like symptoms: fever, fatigue, chills, joint pain, night sweats
- New or changed murmur
- SOB, chest pain with inspiration, tachycardia
- Red spots on hands, fingers, eyes/lids
How does endocarditis present on ECHO?
- vegetations
- regurgitation
- paravalvular abscess
- paravalvular aneurysm
- fistula
- prosthetic valve dehiscence
How do VEGETATIONS appear on echo?
- Irregularly shaped, small pedunculated masses adhered to thickened valve
- Attached to proximal side of valve (MV → LA side ; AV → LV side)
- Exhibits chaotic motion
Regurgitation due to endocarditis on echo is due to?
to leaflet destruction i.e. perforation or from vegetation preventing closure
Paravalvular abscess due to endocarditis appears as what?
an echolucent contour outpouching of the infected annulus
Who are CANDIDATES for endocarditis?
- Patients with preexisting valvular heart disease (rheumatic)
- Valve prosthesis or other artificial devices/catheters/wires
- Congenital abnormalities
- IV drug users/past history of endocarditis
- Recent surgical, dental, or medical procedures; gum disease
- Lupus, AIDS, autoimmune patients
Endocarditis on AUTOIMMUNE patients is what type?
marantic = noninfectious/nonbacterial
Vegetations on AUTOIMMUNE patients are called what?
Libman Sachs
NON PRIMARY TUMORS are due from what?
another source
What are the common sites of origin for NON PRIMARY TUMORS?
- Lung, breast, blood account for ¾
- Lymph ( lymphomas associated with AIDS have frequent and extensive cardiac involvement)
- Others: stomach, skin, melanoma (high rate of pericardial metastases), liver and colon
NON PRIMARY TUMORS often involve what?
the pericardium/epicardium
How does NON PRIMARY tumors present on echo?
- malignant pericardial effusion
- pericardial masses, myocardial masses
- invading masses from adjacent malignancies
- extension type tumors
- carcinoid heart disease
What are the types of EXTENSION TUMORS for Non Primary?
- renal cell carcinoma - fingerlike projection from kidney into RA from IVC
- hepatoma - from liver thru IVC
- uterine tumors
- others that migrate thru PVs
What is CARCINOID HEART DISEASE?
when metastatic carcinoid tissue in liver produces serotonin leading to thickening, retraction and rigidity of TV, PV and regurgitation
PRIMARY TUMORS originate where?
the heart
What % of PRIMARY tumors are benign?
75%
What are the TYPES of BENIGN tumors?
- Myxomas
- Papillary Fibroelastoma
- Hemagiomas
- Mesothelioma on AV node
- Lipomatous hypertrophy
- Pericardial or bronchogenic cyst
- Fibroma
- Rhabdomyoma
What are the TYPE of MALIGNANT tumors?
- Angiosarcomas
- Rhabdomyosarcomas
- Pericardial Mesotheliomas
- Fibrosarcomas
How do ANGIOSARCOMAS PRESENT?
as bloody effusion with tamponade and atrial or pericardial wall masses
How RHABDOMYOSARCOMAS PRESENT?
forms in soft tissue; striated muscle
How do PERICARDIAL MESOTHELIOMAS PRESENT?
forms in pericardial lining due to asbestos exposure
How do FIBROSARCOMAS PRESENT?
forms in fibrous tissue of the heart
What is the most common type of CARDIAC MASS?
thrombus
Name the FOUR types of CARDIAC THROMBUS
- LV thrombus
- LA thrombus
- Right heart thrombus
- Extracardiac thrombus
