Intracardiac Masses Flashcards
(53 cards)
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
2
Q
The ____ and ____ of the tumor determine the clinical findings, not the histopathology
A
anatomic location and size
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
4
Q
valvular manifestations of cardiac tumors
A
- Valvular damage, obstruction, or regurgitation
- Congestive heart failure
- Sudden death or syncope
5
Q
pericardial manifestations of cardiac tumors
A
- Pericarditis
- Pericardial effusion
- Arrhythmias
- Tamponade
- Constriction
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
7
Q
clinical manifestation types of a cardiac tumor
A
- endocaridal
- valvular
- pericardial
- myocardial
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
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
10
Q
most primary cardiac tumors are ?
A
benign; 75-95%
11
Q
MC primary cardiac tumors
A
- cardiac myxoma
- papillary fibroelastomas
12
Q
MC cardiac tumor in kids
A
rhabdomyomas
Typically occurs before the age 1
13
Q
prevalence of myxoma
A
- 50% of benign cardiac tumors
- 30-60 y/o - avg 51
- sporadic and isolated
- <10% familial (autosomal dominant)- Avg 25 y/o; more likely to have multiple and recurrent tumors
14
Q
- Pedunculated and gelatinous in consistency
- surface may be smooth, irregular, or friable
this description is for what primary cardiac tumor
A
myxoma
15
Q
what type of myxomas associated w/ a higher risk of embolization
A
Friable or villous
16
Q
what type of myxoma tends to present with obstructive cardiovascular symptoms
A
Larger tumors with a smooth surface
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
18
Q
which primary cardiac tumor presents with the “tumor plop”
- Caused by obstruction of MV opening by tumor
- 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
19
Q
dx and tx for myxoma
A
-
dx: echo or pathology of embolic material
- Cardiac MRI can be a useful adjunct -
tx → surgical excision
- Recurrences can occur thus serial echo f/up is recommended
20
Q
Look like a sea anemone, attached to the endocardial surface of the valves by a small pedicle
A
Papillary Fibroelastoma
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
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
upon echo you see a “dumbbell” shaped sparing of fossa ovalis in lipomatous interatrial septal hypertrophy
what is this indicative of?
cardiac lipoma
26
cardiac fibromas are MC in who?
* Can occur at any age, but **MC in pediatric** (75%)
* **2nd MC benign pediatric cardiac tumor**
27
fibromas can occur where in the heart, and where can it happen MC?
* Can occur in **any chamber**
* **_MC ventricular myocardium_**, esp anterior wall of the LV and interventricular septum
28
Typically large in size; 4 to 7 cm
Not distinctly encapsulated - Makes complete resection challenging
what type of primary tumor
fibroma
Result in sx of HF, ventricular arrhythmias, and sudden death d/t mass effect
29
where can rhabdomyomas occur?
* 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
management for rhabdomyoma
Unless the pt is symptomatic, **surgical intervention is often unnecessary**
Spontaneous regression is common
31
MC malignant primary tumor type
-sarcoma
MC malignant cardiac tumors in adults - 20-49y
32
what is the most common histologic subtype of malignant primary tumor, followed by what else?
* **angioscarcomas**
* rhabdomyosarcomas, fibrosarcomas, and osteosarcomas
33
malignant tumors are extensively ___ and ____ at time of diagnosis is common
infiltrative and metastasis
34
what are lymphomas?
* 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
Invasive in the pericardium
MC primary pericardial tumor
**Mesothelioma**
Involve most of parietal and visceral surfaces, with only superficial invasion of adjacent myocardium
36
Mesothelioma MC begins where in the heart
**AV node**
may result in heart block
37
mesothelioma of the heart is MC in who
MC in **adults, males**
***NOT** consistently linked to asbestos exposure*
38
presentation and management of mesothelioma
* pericarditis, tamponade, or constriction
* Poor response with radiation and chemo; surgical pericardiectomy - palliative measure
39
Cardiac metastases occur how much more often than primary tumors of the heart
30x
40
Cardiac metastases often present as ?
pericardial effusions
41
Cancers with high likelihood of metastasis to the heart:
* **Melanoma (MC)**
* Lung CA
* Leukemia and lymphoma
* Renal cell CA
* Breast CA
* Liver and esophageal CA
42
Malignant cells from any single source can metastasize to the heart via ____ and can often _____
multiple routes
seed in multiple cardiac structures
43
modes of spread of secondary/metastatic cardiac tumors
* 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
Intracardiac thrombi develop as a result of
stasis of blood
45
Intracardiac Thrombus MC occurs where?
**Left side** - LA, LV (apex)
46
intracardiac thrombus may result in ____, such as CVA/TIA, mesenteric ischemia, acute limb ischemia
embolic events
47
dx/imaging for intracrdiac thrombus
echo
48
causes of LA thrombus
* **A. fib (#1)**
* LA appendage
* Mitral stenosis
49
causes of Left Ventricular Thrombus
* **Dilated cardiomyopathy (#1)**
* MI resulting in decreased apical wall motion
* Stress cardiomyopathy
50
Most LV thrombi are stable > LA thrombi after about how many days?
why?
30 days
they wall themselves off
51
The only long-term oral anticoagulant approved for intracardiac thrombus tx
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
When do we use prophylaxis to prevent thrombus development?
Only in A. Fib!
53
Thrombectomy is indicated for intracrdiac thrombus if?
1. undergo open-heart surgery for another reason
1. Failure of anticoagulation
1. Anticoagulation is CI
