Intracardiac Masses - Exam 3

Question 1

What are the 2 different types of cardiac tumors?

Answer 1

primary tumors of the heart

metastasis of a distant noncardiac primary tumor

Question 2

What 2 findings determine the clinical finding of a cardiac tumor? NOT ______

Answer 2

anatomic location and size

NOT the histopathology

Question 3

______ is helpful when diagnosing cardiac tumors. **______ is the diagnostic of choice

Answer 3

echocardiography

**cardiac MRI/gated CT

Question 4

What is the management for cardiac tumors?

Answer 4

surgical excision is mainstay

cardiac transplant is also an alternative therapy for unresectable cardiac tumors when infiltration is too extensive

Question 5

What are the top two types of benign primary tumors?

Answer 5

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

Question 6

**______ represent the most common type of primary cardiac tumor in kids

Answer 6

Rhabdomyomas

Question 7

Myxoma are typically found in ______ and papillary fibroelastomas are typically found in _______.

Answer 7

left atrium

cardiac valves

Question 8

myxomas make up ____ of cardiac tumors. What is the typical age range? If inherited they are ______

Answer 8

50%

between 30-60. mean age is 51

autosomal dominant

Question 9

_____ myxomas are associated with a higher risk of ______. If the tumor is smooth, how does it tend to present?

Answer 9

Friable or villous

embolization

large tumors with smooth surface tend to present with OBSTRUCTIVE CV symptoms

Question 10

What is the classic PE finding associated with myxomas? What is it caused by? What extra heart sound?

Answer 10

“tumor plop”

Caused by the obstruction of the mitral valve opening by the tumor

An early diastolic extra heart sound

Question 11

How is myxoma dx made? What is the tx?

Answer 11

Diagnosis made via echo or pathology of embolic material
-Cardiac MRI can be a useful adjunct

surgical excision

Question 12

What is the typical age range for papillary fibroelastoma? What do they typically look like? Where is the MC site?

Answer 12

> 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

Question 13

What 3 words would you use to describe a lipoma? Where is the MC location?

Answer 13

Solitary, circumscribed, encapsulated

Subendocardial protruding into cardiac chamber (MC)

Question 14

_____ are the second MC benign pediatric cardiac tumor. **Where is the MC location?

Answer 14

fibroma, but can occur at any age

**ventricular myocardium especially the anterior wall of the LV and the interventricular septum

aka typically very large

Question 15

What size in cm are fibromas typically? Do they tend to be capsulated?

Answer 15

large in size; 4 to 7 cm

NOT distinctly encapsulated

Question 16

_____ is the most common cardiac tumor in children. Where do you commonly find them? Describe the pattern

Answer 16

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

Question 17

What is the tx for rhabdomyoma? Give asymptomatic and symptomatic

Answer 17

asymptomatic: nothing!! spontaneous regression is common

symptomatic: sx

Question 18

______ are the MC malignant cardiac tumors in adults. _____ are the most common histologic subtype. What age range?

Answer 18

Sarcoma

angiosarcomas

20-49

Question 19

primary cardiac ______ is extremely rare and can involve any area of the heart

Answer 19

lymphoma

Question 20

______ are known as the “dual identity” tumor/ **Where is the MC location? Where do they normally begin? What do they result in?

Answer 20

Mesothelioma

MC primary pericardial tumor: aka think pericardial tumor

begin in the AV node

result in heart block

Question 21

How will mesothelioma present in the heart? Is it linked to asbestos exposure? What is the prognosis? _____ offers palliative care measures

Answer 21

Presents with pericarditis, tamponade, or constriction

NOT consistently linked to asbestos

does NOT respond well to radiation/chemo

pericardiectomy

Question 22

secondary cardiac metastasis occurs ____ more often than primary tumors. **How does it present?

Answer 22

30 times

pericardial effusions

Question 23

What are 6 types of cancer that are likely to spread to the heart? **Which 2 are the MC?

Answer 23

Melanoma (MC)
**Lung CA
Leukemia and lymphoma
Renal cell CA
**Breast CA
Liver and esophageal CA

Lung and Breast are MC

Question 24

What are 4 routes that cancer likes to spread into the heart leading to secondary cardiac tumors?

Answer 24

-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

Question 25

Where do intracardiac thrombus most frequently form? **Diagnosis is made by ______

Answer 25

left side

Left atrium
Left ventricle – particularly the apex

echocardiogram

Question 26

What are 2 causes of left ATRIAL thrombus? Which one is MC?

Answer 26

a fib- MC

mitral stenosis

Question 27

What are 3 causes of left VENTRICULAR thrombus? What is the MC?

Answer 27

Dilated cardiomyopathy- MC

MI resulting in decreased apical wall motion

Stress cardiomyopathy

Question 28

Are ventricular or atrial clots more stable? After what day?

Answer 28

ventricular clots are more stable than atria

especially after 30 days because they wall themselves off

Question 29

When do we use prophylaxis to prevent thrombus development? What is the tx for intracardiac thrombi?

Answer 29

only if afib is present!

warfarin

Question 30

What is the goal INR for intracardiac thrombi? How long?

Answer 30

2-3

Should remain on warfarin at LEAST 3 mos.
Can consider DOAC after for long term prevention

Question 31

When is a thrombectomy indicated in intracardiac thrombus?

Answer 31

-Patient is going to undergo open-heart surgery for another reason

-Failure of anticoagulation

-Anticoagulation is contraindicated