Intracardiac Masses Flashcards
Symptoms of heart tumor
Typically show symptoms or PE suggestive
Essential of diagnosis of heart tumor
Tissue biopsy
What is the MC type of cardiac tumor?
Metastatic
Endocardial tumor clinical manifestation
Thromboembolism
cerebral, coronary, pulmonary, systemic
Cavitary obliteration or outflow tract obstruction
Valve obstruction and valve damage
Constitutional manifestations¹
Common symptoms of cancer
Fever, night sweats, fatigue
constitutional symptoms
What tumor can lead to sudden death or syncope and why?
Valvular damage, obstruction, or regurgitation
Congestive heart failure
Pericardial tumors can cause
Pericarditis
Pericardial effusion
Arrhythmias
Tamponade
Constriction
Myocardial tumors can cause
Arrhythmias, ventricular or atrial
Conduction abnormalities
Electrocardiographic changes
Systolic or diastolic left ventricular dysfunction
Coronary involvement: angina, infarction
What do you sometimes see on cxr for for cardiac tumors
abnormal cardiac contour on CXR
gated CT
watch cardiac cycle and take images at the correct time
Diagnostic imaging of choice for cardiac tumors
Cardiac MRI/gated CT¹
diagnostic procedure of choice for all cardiac tumors
Mainstay management of cardiac tumors
Surgical excision
Some tumors may require radiation or chemotherapy
Why is cardiac transplant not common for cardiac tumors
Poor prognosis = poor candidate for excision
MC benign primary tumors in adults?
MC benign primary tumor in kids?
Adults: Cardiac myxoma MC also papillary fibroelastomas
Kids: Rhabdomyomas
What do cardiac myxomas look like and where are they often found?
Mushroom: pedunculated, friable (can break off and go to the rest of the body)
Found in 50 yo
sporadic and isolated
present with obstructive CV symptoms (stroke symptoms, left atrial mass)
What is the heart sound heard in myxocma and why?
Tumor falls into LV during dyastolic filling
tumor plop
An early diastolic extra heart sound
Diagnosis modality of choice for myxomas
echo or pathology of embolic material
Definitive treatment of myxomas
surgical excision with serial echos d/t high likelyhood of recurrence
Shape of papillary fibroelastomas
sea anemone, finger like projections on the valve
risk of clotting!
Typical patient of papillary fibroelastoma
> 60 yo
often found postmortem
MC valve of papillary fibroelastoma
MC left-sided valves, AV>MV
Primary cardiac Lipoma
Solitary, circumscribed, encapsulated tumors with a wide range of size and weight
MC location of lipoma
Subendocardial protruding into cardiac chamber (MC)
Arise in epicardial space and grow into the pericardial space
Intramyocardial lesion
Shape of lipoma?
Dumbell shape
MC demographic of fibroma and complication
Children (75% of the time)
Often get large and decrease BF in LV
MC chamber of the heart for fibroma
ventricular myocardium
characteristics of fibroma
Typically large in size; 4 to 7 cm
Not distinctly encapsulated, unlike lipomas
Makes complete resection challenging
Result in symptoms of heart failure, ventricular arrhythmias, and sudden death due to mass effect
Patient population of Rhabdomyoma
typically before 1 year
even before being born
no treatment
often more than one
not a big deal because of sponataneous regression
Malignant primary cardiac tumors end route
have the root -sarcoma
Characteristics of sarcoma
50–75% of all primary cardiac malignancies
MC malignant cardiac tumors in adults
Most common in patients 20-49
MC type of sarcoma?
Angiosarcomas
By the time you pick up a cardiac sarcoma, what can you bet?
It has metastasis
VERY poor prognosis worse than pancreatic cancer
looks like a cotton ball spotted with paint
Lymphoma
Cancer goes from lymph to the blood to the heart
TERRIBLE prognosis :(
Mesothelioma cardiac
Dual identity tumor
Invasive in the pericardium
MC primary malignant pericardial tumor
Involve most of the parietal and visceral surfaces encasing the heart, with only superficial invasion of adjacent myocardium
Begin in the AV node
May result in heart block
demographic of mesothelioma
MC in adults, 2:1 male predominance
not d/t asbestos
pericarditis, tamponade, or constriction
often treat thinking it is something else, and then it does not respond to treatment
responses to radiation and chemotherapy are poor; surgical pericardiectomy offers a palliative measure
MC Secondary metastatic cardiac tumor
Melanoma (MC)
close second is renal cell carcinoma
involvement of secondary/metastatic cardiac tumor
Myocardial > coronary > intracavitary involvement occur uncommonly
symptoms of right atrial block
Edema, right sided HF
Intracardiac thrombus is caused by
Stasis of blood from an appendage
What side of the heart is affected with intracardiac thrombus
left side
left atrium
left ventricle – particularly the apex
What can result from intracardiac thrombus? What is the diagnostic modality of choice for an intracardiac thrombus?
May result in embolic events, such as CVA/TIA, mesenteric ischemia, acute limb ischemia
Otherwise asymptomatic
Diagnosis is made by echocardiogram
Left atrial thrombosis causes
A. fib (#1)
Left atrial appendage
Mitral stenosis
Left ventricular thrombus causes
Causes?
Dilated cardiomyopathy (#1)
MI resulting in decreased apical wall motion
Stress cardiomyopathy
Most LV thrombi are more stable than LA thrombi after about 30 days because they wall themselves off
treatment of intracardiac thrombus
Prophyaxis in A fib with anticoagulants
Warfarin if you have an issue (2.0-3.0) for at least 3 months
If someone has a CI of anticoagulation
Major bleeding
Mass in brain
Can use a thromboectomy
