Intracardiac Masses Flashcards by Seth Northway

Symptoms of heart tumor

Typically show symptoms or PE suggestive

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Essential of diagnosis of heart tumor

Tissue biopsy

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What is the MC type of cardiac tumor?

Metastatic

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Endocardial tumor clinical manifestation

Thromboembolism

cerebral, coronary, pulmonary, systemic
Cavitary obliteration or outflow tract obstruction
Valve obstruction and valve damage
Constitutional manifestations¹

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Common symptoms of cancer

Fever, night sweats, fatigue

constitutional symptoms

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What tumor can lead to sudden death or syncope and why?

Valvular damage, obstruction, or regurgitation
Congestive heart failure

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Pericardial tumors can cause

Pericarditis
Pericardial effusion
Arrhythmias
Tamponade
Constriction

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Myocardial tumors can cause

Arrhythmias, ventricular or atrial
Conduction abnormalities
Electrocardiographic changes
Systolic or diastolic left ventricular dysfunction
Coronary involvement: angina, infarction

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What do you sometimes see on cxr for for cardiac tumors

abnormal cardiac contour on CXR

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gated CT

watch cardiac cycle and take images at the correct time

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Diagnostic imaging of choice for cardiac tumors

Cardiac MRI/gated CT¹

diagnostic procedure of choice for all cardiac tumors

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Mainstay management of cardiac tumors

Surgical excision

Some tumors may require radiation or chemotherapy

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Why is cardiac transplant not common for cardiac tumors

Poor prognosis = poor candidate for excision

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MC benign primary tumors in adults?
MC benign primary tumor in kids?

Adults: Cardiac myxoma MC also papillary fibroelastomas

Kids: Rhabdomyomas

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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)

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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

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Diagnosis modality of choice for myxomas

echo or pathology of embolic material

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Definitive treatment of myxomas

surgical excision with serial echos d/t high likelyhood of recurrence

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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