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Cardiology (Fall 2023) > Lecture 17: Intracardiac Masses > Flashcards

Lecture 17: Intracardiac Masses Flashcards

1
Q

How are cardiac tumors classified?

A

Anatomic location and size

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2
Q

What is the hallmark sign of an endocardial cardiac tumor?

A

Thromboembolism

also see constitutional s/s and valve obstruction or damage

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3
Q

What characterizes a valvular cardiac tumor?

A
  • Valvular damage, obstruction or regurg
  • CHF
  • Sudden death or syncope
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4
Q

What characterizes a pericardial cardiac tumor?

A
  • Pericarditis
  • Pericardial effusion
  • Arrhythmias
  • Tamponade
  • Constriction
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5
Q

What characterizes a myocardial pericardiac tumor?

A
  • Arrhythmias, ventricular or atrial
  • Conduction abnormalities
  • EKG changes
  • Systolic or diastolic LV dysfunction
  • Coronary involvement: angina, infarction
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6
Q

What is the imaging modality of choice for diagnosing cardiac tumors?

A

Cardiac MRI/gated CT

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7
Q

What is the main weakness of using echos to find cardiac tumors?

A

Cannot detect ventricular wall tumors

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8
Q

What is the mainstay of treatment for cardiac tumors?

A

Surgical excision

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9
Q

How do most primary tumors of the heart present?

A

Benign

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10
Q

What is the MC benign primary cardiac tumor in kids?

A

Rhabdomyomas

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11
Q

What is the MC primary cardiac tumor in adults?

A

Cardiac myxomas

Papillary fibroelastoma is increasing tho

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12
Q

When are most cardiac myxomas found?

A

30-60

Sporadic and isolated

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13
Q

Describe a cardiac myxoma.

A
  • Pedunculated and gelatinous in consistency
  • Friable or villous = high embolus risk
  • Larger = obstruction CV symptoms
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14
Q

Where is the MC location of a primary cardiac myxoma to be found?

A

Left atrium

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15
Q

What is the classic finding for a primary cardiac myxoma?

A

Tumor plop (later than OS but slightly earlier than S3)

Early diastolic heart sound that probably needs an echo.

sound created by obstruction of mitral valve opening

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16
Q

How is a primary cardiac myxoma diagnosed and treated?

A
  • Diagnosis: Echo or Pathology
  • Tx: Excision (need f/u echo d/t high rate of recurrence)
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17
Q

When are papillary fibroelastomas typically found?

A

> 60 y/o

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18
Q

Where does a papillary fibroelastoma tend to appear?

A

MC on the left sided valves, mainly AV

Looks like a sea anenome or dandelion

19
Q

What are the clinical manifestations of a papillary fibroelastoma?

A
  • Cerebral embolism
  • Myocardiac infarction
  • Sudden death
  • PE
  • Syncope
20
Q

How do primary cardiac lipomas usually look like?

A

Solitary, circumscribed, encapsulated tumor found in the subendocardium protruding into the cardiac chamber

21
Q

When are primary cardiac fibromas usually found?

A

Pediatric population (2nd MC benign in children after rhabdomyomas)

22
Q

Where do primary cardiac fibromas tend to appear?

A

Ventricular myocardium, esp in the anterior wall of the LV or interventricular septum.

23
Q

What are most S/S of a fibroma due to?

A

Mass effect (it is huge and NOT encapsulated)

Hard to resect since not encapsulated

24
Q

What is the MC benign cardiac tumor in children?

A

Rhabdomyomas (prior to age 1 usually)

25
Q

Where do rhabdomyomas tend to appear?

A

Sprinkled throughout all the chambers but rarely found on valves

26
Q

What is the typical approach to rhabdomyomas?

A

Watchful waiting since spontaneous regression is common.

Surgical intervention is often unnecessary

27
Q

What is the MC type of sarcoma?

A

Angiosarcoma

28
Q

What is the MC type of malignant cardiac tumor in adults?

A

Sarcomas

V poor prognosis

29
Q

What is the MC primary pericardial tumor?

A

Mesothelioma

30
Q

Where does mesothelioma tend to begin at?

A

AV node

31
Q

What is unique about cardiac mesothelioma?

A
  • Male adults
  • NOT linked to asbestos exposure
32
Q

What is the palliative treatment for mesothelioma?

A

Surgical Pericardiectomy

33
Q

What is more common: mets to the heart or primary cardiac tumors?

A

Mets to the heart

34
Q

What is the MC type of cancer to metastasize to the heart?

A

Melanoma

35
Q

How do cardiac metastases tend to appear?

A

Pericardial effusions

Typically only involves pericardium.

36
Q

What is the primary cause of intracardiac thrombus?

A

Stasis of blood

37
Q

Where do intracardiac thrombi tend to occur?

A

Left side of the heart

38
Q

What is the #1 cause of a Left atrial thrombus?

A

Afib causing stasis within the left atrial appendage

39
Q

What is unique about LV thrombi?

A

They are very stable and wall themselves off, so no emboli really come from them.

40
Q

What is the MCC of a left ventricular thrombus?

A

Dilated CM

41
Q

What is the only anticoagulant used for TREATMENT of intracardiac thrombi?

AKA they already HAVE A THROMBUS IN THEIR HEART

A

Warfarin with INR of 2-3

The goal is for the body to resorb the clot that has already formed.

42
Q

What is the only indication for prophylaxis of thrombus development?

A

Afib

43
Q

What are the indications for thrombectomy?

A
  1. Pt already undergoing open-heart surgery for something else
  2. Failure of anticoagulation
  3. Anticoagulation contraindicated

Cardiology (Fall 2023) (45 decks)

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