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Cardiovascular > Intracardiac Masses > Flashcards

Intracardiac Masses Flashcards

1
Q

What are essentials of diagnosis of intracardiac masses?

A
  • Rare but critical
  • Confirmation requires tissue biopsy (but H&P and imaging hold valuable diagnostic clues)
  • Surgical excision is mainstay of treatment
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2
Q

What are the 2 types of intracardiac tumors?

A

Primary and metastasis

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3
Q

If a patient is symptomatic, a cardiac mass can almost always be detected by what?

A

Echo, MRI, and/or CT

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4
Q

What determines the clinical findings of cardiac tumors?

A

Anatomic location and size

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5
Q

What are characteristics of a endocardial cardiac tumor?

A
  • Thromboembolism: cerebral, coronary. pulmonary, systemic
  • Cavitary obliteration or outflow tract obstruction
  • Valve obstruction and valve damage
  • Constitutional manifestations
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6
Q

What are characteristics of a valvular cardiac tumor?

A
  • Valvular damage, obstruction, or regurgitation
  • Congestive heart failure
  • Sudden death or syncope
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7
Q

What are characteristics of a pericardial tumor?

A
  • Pericarditis
  • Pericardial effusion
  • Arrhythmias
  • Tamponade
  • Constriction
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8
Q

What are characteristics of a myocardial cardiac tumor?

A
  • Arrhythmias, ventricular or atrial
  • Conduction abnormalities
  • Electrocardiographic changes
  • Systolic or diastolic left ventricular dysfunction
  • Coronary involvement: angina, infarction
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9
Q

How are cardiac tumors diagnosed?

A
  • May be discovered as abnormal cardiac contour on CXR
  • Echo (but may miss ventricular wall tumors)
  • Cardiac MRI/gated CT = diagnostric procedure of choice
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10
Q

How are cardiac tumors managed?

A
  • Surgical excsision = mainstay, especially if symptomatic
  • Some require radiation or chemo
  • Cardiac transplantation for unresectable cardiac tumors or extensive infiltration
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11
Q

What is the epidemiology of benign primary tumors?

A
  • Rare (.02%)
  • Cardiac myxoma = traditional MC tumor in adults
  • Now papillary fibroelastomas thought higher frequency
  • Rhabdomyomas MC in kids
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12
Q

What is the epidemiology of myxomas?

A
  • 50% of benign cardiac tumors
  • Usually between 30 and 60 years old, mean age at diagnosis = 51
  • Familial autosomal dominant mean age = 25 and more likely have multiple recurrent tumors
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13
Q

What are characteristics of myxomas?

A
  • Pedunculated and gelatinous consistency
  • Surface smooth, irregular, or friable
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14
Q

What are friable or villous myxomas associated with? Larger myxomas?

A
  • Friable or villous = higher risk of embolization
  • Larger tumors = obstructive cardiovascular symptoms
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15
Q

How do the majority of myxomas present?

A
  • In L atrium with stalk attached to interatrial septum (near fossa ovalis)
  • Presents with tumor plop
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16
Q

What is a tumor plop?

A
  • Obstruction of mitral valve opening by tumor
  • Early diastolic heart sound

Later than opening snap of a stenotic mitral valve and earlier than S3

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17
Q

How is a myxoma diagnosed?

A
  • Echo or pathology of embolic material
  • Cardiac MRI = adjunct
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18
Q

How is a myxoma treated?

A

Surgical excision

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19
Q

What is the epidemiology of a papillary fibroelastoma?

A
  • 8% of cardiac tumors
  • Usually patients >60
  • Also called papillary endocardial tumor, cardiac papilloma, or giant Lambl’s excrescence
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20
Q

What are characteristics of papillary fibroelastoma?

A
  • Looks like sea anemone
  • Attaches to endocardial surface of valves by pedicle
  • MC left-sided valves, AV > MV
21
Q

what are clinical manifestations of papillary fibroelastoma?

A
  • Cerebral embolism
  • Myocardial Infarction
  • Sudden death
  • Pulmonary embolism
  • Syncope
22
Q

What are characteristics of lipomas?

A

Account for 8% of primary cardiac tumors
* Solitary, circumscribed, encapsulated with wide range of size and weight
* Location: subendocardial protruding into cardiac chamber, arise in epicardial space and grow into pericardial space, or intramyocardial lesion

23
Q

What is the epidemiology of fibroma?

A
  • More commonly in pediatric population
  • Second MC benign pediatric cardiac tumor
24
Q

What is the location of fibromas?

A
  • Any chamber
  • MC ventricular myocardium, especially anterior wall of LV and interventricular septum
25
Q

What are characteristics of fibromas?

A
  • Typically large (4-7 cm)
  • Not encapsulated
26
Q

What do fibromas result in?

A
  • heart failure
  • ventricular arrhythmias
  • sudden death due to mass effect
27
Q

What is the usual location of rhabdomyomas?

A
  • any chamber but spares the valves
  • typically multiple at one time
28
Q

how is rhabdomyoma treated?

A
  • Usually not treated unless symptomatic
29
Q

What ending should you keep an eye out for as malignant?

A

sarcoma + cardiac lymphomas, epitheliod hemangioendothelioma, malignant pleomorphic fibrous histiocytoma, malignant mesothelioma

30
Q

What is the epidemiology of sarcoma?

A
  • majority of primary cardiac malignancies and MC malignant in adult
  • MC age 20-49
  • Angiosarcomas MC subtype
31
Q

What are characteristics of sarcomas?

A
  • Extensive infiltration and metastasis at time of diagnosis common
  • Very poor prognosis :(
32
Q

Where is mesothelioma commonly located?

A
  • “DUAL IDENTITY”
  • Invasive in pericardium, most parietal and visceral surfaces encasing with only superficial invasion of adjacent myocardium
  • Begin in AV node and may result in heart block
33
Q

Who more commonly gets mesothelioma?

A

Adult men

34
Q

How does mesothelioma present?

A
  • Pericarditis
  • Tamponade
  • Constriction
35
Q

what can be used as a palliative measure for mesothelioma?

A

surgical pericardiectomy

36
Q

How do cardiac metastases often present?

A

Pericardial effusions

37
Q

Do cardiac metastases or primary tumors of the heart occur more frequently?

A

Cardiac metastases

38
Q

What cancers have high likelihood of metastasis to the heart?

A
  • Melanoma
  • Renal cell CA
  • Lung CA
  • Breast CA
  • Leukemia and lymphoma
  • Liver and esophageal CA
39
Q

How can malignant cells spread to the heart?

A
  • Lymphatic and hematogenous spread
  • Direct local invasion from mediastinal structures
  • Extension of tumor thrombus through inferior vena cava
  • Myocardial –> coronary –> intracavitary involvement occur uncommonly
40
Q

Why do intracardiac thrombus develop?

A

Stasis of blood

41
Q

Where are intracardiac thrombi most common?

A

Left side of heart

42
Q

What can intracardiac thrombi cause?

A

Embolic events such as CVA/TIA, mesenteric ischemia, acute limb ischemia

43
Q
A
44
Q

How is diagnosis of intracardiac thrombus made?

A

By echocardiogram

45
Q

What are causes of left atrial thrombus?

A
  • Afib
  • Left atrial appendage
  • Mitral stenosis
46
Q

What are causes of left ventricular thrombus?

A
  • Dilated cardiomyopathy
  • MI resulting in decreased apical wall motion
  • Stress cardiomyopathy

Most more stable than LV thrombi after 30 days because wall self off

47
Q

How is intracardiac thrombus managed?

A
  • Anticoagulation prophylaxis in a. fib
  • Warfarin only approved oral long term
  • Thrombectomy if open heart surgery, failure/CI to anticoag
48
Q

What is the goal INR for warfarin use for intracardiac thrombi? How long should it be used?

A

2.0 to 3.0
at least 3 months

Patients hsould be hospitalized for initiation of warfarin while bridging with heparin or lovenox

49
Q
A

Cardiovascular (17 decks)

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