Neoplastic

Question 1

What % of cardiac tumors are benign?

Answer 1

75%

Question 2

What are examples of benign cardiac neoplasms?

Answer 2

Myxoma (45%), lipoma (20%), papillary fibroelastoma (15%), angioma (5%), hemangioma (5%), fibroma (3%), rhabdomyoma (1%), teratoma (<1%)

Question 3

What is the most common benign cardiac tumor?

Answer 3

Myxoma (45%)

Question 4

Describe a cardiac myxoma

Answer 4

Slow-growing, peduculated mass consisting of a mucopolysaccride myxoid matrix; it is non-homogenous on TEE

Question 5

Where are cardiac myxomas mostly found?

Answer 5

75% are found in the LA

Question 6

Who is more at risk for cardiac myxomas?

Answer 6

Women between the ages of 30-60yo

Question 7

What are symptoms of a cardiac myxoma?

Answer 7

Embolization, intracardiac obstruction, and constitutional symptoms (i.e. palpitations, syncope, CHF)

Question 8

Where are papillary fibroelastomas most likely to be found?

Answer 8

Ventricular side of the aortic valve (45%); less commonly they are found on the atrial side of the mitral valve (36%)

Question 9

What is the primary symptom associated with a papillary fibroelastoma?

Answer 9

S/s of embolization

Question 10

How can you tell the difference between a papillary fibroelastoma vs Lambl’s Excrescence?

Answer 10

PF looks like organization of thrombi while LE looks like endothelial damage; PF is very rare while LE is found in 70% of patients; LE are often seen in multiples while PF are not

Question 11

What is a cardiac lipoma?

Answer 11

Encapsulated tumors made of mature fat cells that are often asymptomatic and can occur anywhere in the heart

Question 12

What is the most common malignant cardiac tumor?

Answer 12

Sarcomas (angiosarcoma or rhabdomyosarcomas)

Question 13

Where are cardiac sarcomas mostly found?

Answer 13

In the RA

Question 14

Where do secondary cardiac tumors arise from?

Answer 14

Direct extension from tumors of the breast, lung, esophagus, and mediastinum + via venous spread from renal, adrenal, thyroid. lung, and liver primary tumors + lymphatic spread from lymphoma or leukemias

Question 15

What are cardiac carcinoid tumors?

Answer 15

Metastasizing neuroendocrine tumors typically from the small bowel (never primary cardiac tumors)

Question 16

When do you have symptoms from carcinoid tumors?

Answer 16

If patient has liver mets, you can have cardiac symptoms (5-HT is normally broken down in the liver but it is now bypassed) + left-sided sypmtoms if there are bronchial mets (lungs also can break down 5-HT)

Question 17

What are some sequelae that can occur from cardiac carcinoid tumors?

Answer 17

Carcinoid plaque can be deposited on the TV and PV causing immobility and thickening of the valve leaflets; TV = thickening, retracted, diastolic doming with TR; PV = pulmonic stenosis; can also cause restrictive cardiomyopathy

Question 18

What imaging modules can you use for diagnosing cardiac tumors?

Answer 18

TTE, cardiac CT/MRI, and TEE

Question 19

What are some anesthetic considerations in patients with cardiac tumors?

Answer 19

Tumor embolization (line placement, cardiac manipulation), hemodynamic collapse (obstruction), collateral damage, arrhythmias

Question 20

Cardiac Myxoma Image

Answer 20

See Excel

Question 21

Papillary Fibroelastoma Image

Answer 21

See Excel

Question 22

Lambl’s Excrescence Image

Answer 22

See Excel

Question 23

Cardiac Lipoma Image

Answer 23

See Excel