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Cardiovascular > Intracardiac Masses > Flashcards

Intracardiac Masses Flashcards

1
Q

2 types of cardiac tumors

A
  • Primary tumor of the heart - Rare!
  • Metastasis of distant noncardiac primary tumor - 100-fold MC > primary tumors
  • May be symptomatic or found incidentally
  • In symptomatic pts, a mass can always be detected by echo, MRI, and/or CT
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2
Q

The ____ and ____ of the tumor determine the clinical findings, not the histopathology

A

anatomic location and size

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3
Q

endocardial manifestations of cardiac tumors

A
  • Thromboembolism: cerebral, coronary, pulmonary, systemic
  • Cavitary obliteration or outflow tract obstruction
  • Valve obstruction and valve damage
  • Constitutional manifestations
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4
Q

valvular manifestations of cardiac tumors

A
  • Valvular damage, obstruction, or regurgitation
  • Congestive heart failure
  • Sudden death or syncope
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5
Q

pericardial manifestations of cardiac tumors

A
  • Pericarditis
  • Pericardial effusion
  • Arrhythmias
  • Tamponade
  • Constriction
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6
Q

myocardial manifestations of cardiac tumors

A
  • Arrhythmias, ventricular or atrial
  • Conduction abnormalities
  • ECG changes
  • Systolic or diastolic left ventricular dysfunction
  • Coronary involvement: angina, infarction
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7
Q

clinical manifestation types of a cardiac tumor

A
  1. endocaridal
  2. valvular
  3. pericardial
  4. myocardial
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8
Q

how to dx cardiac tumors

A
  • abnml cardiac contour on CXR
  • Echo - helpful but can miss ventricular wall tumors
  • Cardiac MRI/gated CT is diagnostic procedure
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9
Q

management for cardiac tumors

A
  • Surgical excision - mainstay; +/- radiation/chemo
  • Transplant - alt for unresectable cardiac tumors when infiltration is too extensive for excision
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10
Q

most primary cardiac tumors are ?

A

benign; 75-95%

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11
Q

MC primary cardiac tumors

A
  1. cardiac myxoma
  2. papillary fibroelastomas
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12
Q

MC cardiac tumor in kids

A

rhabdomyomas

Typically occurs before the age 1

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13
Q

prevalence of myxoma

A
  1. 50% of benign cardiac tumors
  2. 30-60 y/o - avg 51
  3. sporadic and isolated
    - <10% familial (autosomal dominant)- Avg 25 y/o; more likely to have multiple and recurrent tumors
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14
Q
  1. Pedunculated and gelatinous in consistency
  2. surface may be smooth, irregular, or friable

this description is for what primary cardiac tumor

A

myxoma

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15
Q

what type of myxomas associated w/ a higher risk of embolization

A

Friable or villous

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16
Q

what type of myxoma tends to present with obstructive cardiovascular symptoms

A

Larger tumors with a smooth surface

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17
Q

About 2/3 of myxomas occur where?

A

left atrium

Arise from endocardial surface of LA w/ a stalk attached to interatrial septum close to the fossa ovalis

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18
Q

which primary cardiac tumor presents with the “tumor plop”

  1. Caused by obstruction of MV opening by tumor
  2. An early diastolic extra heart sound
    - Occurs later than opening snap of a stenotic MV and earlier than an S3, which can be difficult to distinguish with auscultation
A

myxoma

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19
Q

dx and tx for myxoma

A
  1. dx: echo or pathology of embolic material
    - Cardiac MRI can be a useful adjunct
  2. tx → surgical excision
    - Recurrences can occur thus serial echo f/up is recommended
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20
Q

Look like a sea anemone, attached to the endocardial surface of the valves by a small pedicle

A

Papillary Fibroelastoma

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21
Q

Papillary Fibroelastoma affects which valve MC?

A

MC left-sided valves, AV>MV

  • May also appear on the chordae, papillary apparatuses, left ventricular septum, left ventricular outflow tract, left ventricular free wall, and the left atrium
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22
Q

clinical manifestations of Papillary Fibroelastoma

A

cerebral embolism, myocardial infarction, sudden death, pulmonary embolism, and syncope

23
Q

Solitary, circumscribed, encapsulated tumors with a wide range of size and weight

A

Lipoma

24
Q

possible locations of a Lipoma

A
  • Subendocardial protruding into cardiac chamber (MC)
  • Arise in epicardial space and grow into the pericardial space
  • Intramyocardial lesion
25
Q

upon echo you see a “dumbbell” shaped sparing of fossa ovalis in lipomatous interatrial septal hypertrophy
what is this indicative of?

A

cardiac lipoma

26
Q

cardiac fibromas are MC in who?

A
  • Can occur at any age, but MC in pediatric (75%)
  • 2nd MC benign pediatric cardiac tumor
27
Q

fibromas can occur where in the heart, and where can it happen MC?

A
  • Can occur in any chamber
  • MC ventricular myocardium, esp anterior wall of the LV and interventricular septum
28
Q

Typically large in size; 4 to 7 cm
Not distinctly encapsulated - Makes complete resection challenging

what type of primary tumor

A

fibroma

Result in sx of HF, ventricular arrhythmias, and sudden death d/t mass effect

29
Q

where can rhabdomyomas occur?

A
  • Occurs any chamber but usually spares the valves
  • Commonly there are multiple tumors at one time
  • Range in size from a few millimeters to a few centimeters and are white to yellow
30
Q

management for rhabdomyoma

A

Unless the pt is symptomatic, surgical intervention is often unnecessary
Spontaneous regression is common

31
Q

MC malignant primary tumor type

A

-sarcoma
MC malignant cardiac tumors in adults - 20-49y

32
Q

what is the most common histologic subtype of malignant primary tumor, followed by what else?

A
  • angioscarcomas
  • rhabdomyosarcomas, fibrosarcomas, and osteosarcomas
33
Q

malignant tumors are extensively ___ and ____ at time of diagnosis is common

A

infiltrative and metastasis

34
Q

what are lymphomas?

A
  • Primary cardiac lymphoma is extremely rare - 25% pts w/ lymphoma have cardiac involvement at autopsy
  • Can involve any area of the heart
  • Very infiltrative and quick to metastasize
  • Very poor prognosis; mean survival of 7 months after diagnosis
35
Q

Invasive in the pericardium
MC primary pericardial tumor

A

Mesothelioma
Involve most of parietal and visceral surfaces, with only superficial invasion of adjacent myocardium

36
Q

Mesothelioma MC begins where in the heart

A

AV node
may result in heart block

37
Q

mesothelioma of the heart is MC in who

A

MC in adults, males
NOT consistently linked to asbestos exposure

38
Q

presentation and management of mesothelioma

A
  • pericarditis, tamponade, or constriction
  • Poor response with radiation and chemo; surgical pericardiectomy - palliative measure
39
Q

Cardiac metastases occur how much more often than primary tumors of the heart

A

30x

40
Q

Cardiac metastases often present as ?

A

pericardial effusions

41
Q

Cancers with high likelihood of metastasis to the heart:

A
  • Melanoma (MC)
  • Lung CA
  • Leukemia and lymphoma
  • Renal cell CA
  • Breast CA
  • Liver and esophageal CA
42
Q

Malignant cells from any single source can metastasize to the heart via ____ and can often _____

A

multiple routes
seed in multiple cardiac structures

43
Q

modes of spread of secondary/metastatic cardiac tumors

A
  • lymphatic and hematogenous spread
  • direct local invasion from mediastinal structures
  • extension of tumor thrombus into IVC (renal cell carcinoma)

Myocardial > coronary > intracavitary involvement occur uncommonly

44
Q

Intracardiac thrombi develop as a result of

A

stasis of blood

45
Q

Intracardiac Thrombus MC occurs where?

A

Left side - LA, LV (apex)

46
Q

intracardiac thrombus may result in ____, such as CVA/TIA, mesenteric ischemia, acute limb ischemia

A

embolic events

47
Q

dx/imaging for intracrdiac thrombus

A

echo

48
Q

causes of LA thrombus

A
  • A. fib (#1)
  • LA appendage
  • Mitral stenosis
49
Q

causes of Left Ventricular Thrombus

A
  • Dilated cardiomyopathy (#1)
  • MI resulting in decreased apical wall motion
  • Stress cardiomyopathy
50
Q

Most LV thrombi are stable > LA thrombi after about how many days?
why?

A

30 days
they wall themselves off

51
Q

The only long-term oral anticoagulant approved for intracardiac thrombus tx

A
  1. warfarin/Coumadin x 3mo - only long-term oral anticoag approved
    - pts hospitalized for start of warfarin, while bridging with heparin or Lovenox (LMWH)
    - Goal of INR - 2.0-3.0
52
Q

When do we use prophylaxis to prevent thrombus development?

A

Only in A. Fib!

53
Q

Thrombectomy is indicated for intracrdiac thrombus if?

A
  1. undergo open-heart surgery for another reason
  2. Failure of anticoagulation
  3. Anticoagulation is CI

Cardiovascular (24 decks)

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