Intracardiac Masses - Exam 3 Flashcards
What are the 2 different types of cardiac tumors?
primary tumors of the heart
metastasis of a distant noncardiac primary tumor
What 2 findings determine the clinical finding of a cardiac tumor? NOT ______
anatomic location and size
NOT the histopathology
______ is helpful when diagnosing cardiac tumors. **______ is the diagnostic of choice
echocardiography
**cardiac MRI/gated CT
What is the management for cardiac tumors?
surgical excision is mainstay
cardiac transplant is also an alternative therapy for unresectable cardiac tumors when infiltration is too extensive
What are the top two types of benign primary tumors?
Cardiac myxoma was traditionally reported as the most frequent tumor type in adults
Increasing utilization of imaging studies have revealed a higher frequency of papillary fibroelastomas
**______ represent the most common type of primary cardiac tumor in kids
Rhabdomyomas
Myxoma are typically found in ______ and papillary fibroelastomas are typically found in _______.
left atrium
cardiac valves
myxomas make up ____ of cardiac tumors. What is the typical age range? If inherited they are ______
50%
between 30-60. mean age is 51
autosomal dominant
_____ myxomas are associated with a higher risk of ______. If the tumor is smooth, how does it tend to present?
Friable or villous
embolization
large tumors with smooth surface tend to present with OBSTRUCTIVE CV symptoms
What is the classic PE finding associated with myxomas? What is it caused by? What extra heart sound?
“tumor plop”
Caused by the obstruction of the mitral valve opening by the tumor
An early diastolic extra heart sound
How is myxoma dx made? What is the tx?
Diagnosis made via echo or pathology of embolic material
-Cardiac MRI can be a useful adjunct
surgical excision
What is the typical age range for papillary fibroelastoma? What do they typically look like? Where is the MC site?
> 60 years of age
Look like a sea anemone, attached to the endocardial surface of the valves by a small pedicle
MC left-sided valves, AV>MV
What 3 words would you use to describe a lipoma? Where is the MC location?
Solitary, circumscribed, encapsulated
Subendocardial protruding into cardiac chamber (MC)
_____ are the second MC benign pediatric cardiac tumor. **Where is the MC location?
fibroma, but can occur at any age
**ventricular myocardium especially the anterior wall of the LV and the interventricular septum
aka typically very large
What size in cm are fibromas typically? Do they tend to be capsulated?
large in size; 4 to 7 cm
NOT distinctly encapsulated
_____ is the most common cardiac tumor in children. Where do you commonly find them? Describe the pattern
rhabdomyoma
Occurs in any chamber but usually spares the valves
common to have multiple tumors are one time, and unless the pt is SYMPTOMATIC, surgical intervention is often unnecessary
What is the tx for rhabdomyoma? Give asymptomatic and symptomatic
asymptomatic: nothing!! spontaneous regression is common
symptomatic: sx
______ are the MC malignant cardiac tumors in adults. _____ are the most common histologic subtype. What age range?
Sarcoma
angiosarcomas
20-49
primary cardiac ______ is extremely rare and can involve any area of the heart
lymphoma
______ are known as the “dual identity” tumor/ **Where is the MC location? Where do they normally begin? What do they result in?
Mesothelioma
MC primary pericardial tumor: aka think pericardial tumor
begin in the AV node
result in heart block
How will mesothelioma present in the heart? Is it linked to asbestos exposure? What is the prognosis? _____ offers palliative care measures
Presents with pericarditis, tamponade, or constriction
NOT consistently linked to asbestos
does NOT respond well to radiation/chemo
pericardiectomy
secondary cardiac metastasis occurs ____ more often than primary tumors. **How does it present?
30 times
pericardial effusions
What are 6 types of cancer that are likely to spread to the heart? **Which 2 are the MC?
Melanoma (MC)
**Lung CA
Leukemia and lymphoma
Renal cell CA
**Breast CA
Liver and esophageal CA
Lung and Breast are MC
What are 4 routes that cancer likes to spread into the heart leading to secondary cardiac tumors?
-lymphatic
-hematogenous
-direct local invasion from mediastinal structures
-extension of the tumor thrombus into the inferior vena cava, in the case of renal cell carcinoma
Where do intracardiac thrombus most frequently form? **Diagnosis is made by ______
left side
Left atrium
Left ventricle – particularly the apex
echocardiogram
What are 2 causes of left ATRIAL thrombus? Which one is MC?
a fib- MC
mitral stenosis
What are 3 causes of left VENTRICULAR thrombus? What is the MC?
Dilated cardiomyopathy- MC
MI resulting in decreased apical wall motion
Stress cardiomyopathy
Are ventricular or atrial clots more stable? After what day?
ventricular clots are more stable than atria
especially after 30 days because they wall themselves off
When do we use prophylaxis to prevent thrombus development? What is the tx for intracardiac thrombi?
only if afib is present!
warfarin
What is the goal INR for intracardiac thrombi? How long?
2-3
Should remain on warfarin at LEAST 3 mos.
Can consider DOAC after for long term prevention
When is a thrombectomy indicated in intracardiac thrombus?
-Patient is going to undergo open-heart surgery for another reason
-Failure of anticoagulation
-Anticoagulation is contraindicated
