Sunday, April 23, 2017

Cardiac Tumors - A Brief Introduction



Most cardiac tumors are secondary deposits. Cardiac metastasis occurs most commonly with lung and breast carcinomas. The most commonprimary cardiac tumor is a myxoma; 75% of myxomas occur in the left atrium, the remainder in the right atrium and ventricle. Myxomas usually arise from the endocardium at the border of the fossa ovalis as a pedunculated mass. This may prolapse through the mitral valve (MV) mimicking mitral stenosis.

Epidemiology:
The prevalence of myxoma is estimated at 2 per 100,000, most commonly in those aged 30–60 years. The female to male ratio is 2:1.

Clinical presentation:
Myxomas are discovered when individuals present withconstitutional upset or the effects of MV obstruction, or the tumour is an incidental finding. Symptoms include
  • fever,
  • malaise,
  • exertional
  • dyspnoea and
  • weight loss.
  • Transient
  • pulmonary oedema,
  • paroxysmal
  • nocturnal dyspnoea,
  • haemoptysis,
  • dizziness and syncope may occur.
  • The first presentation may be due to an embolic phenomenon.
- Malignant tumors usually present acutely with haemorrhagic pericardial effusions or heart block.
- Renal cell cancer invading the IVC may present with signs of right heart failure and a renal mass.
- Carcinoid metastasis to the tricuspid valve may present with facial flushing and bronchospasm.

Physical signs : Fever, finger clubbing and anemia of chronic disease reflect the chronic nature of myxomas. A tumour ‘plop’ may be heard, or auscultatory findings of mitral stenosis with or without regurgitation may be present. The murmur varies with posture, unlike in cases of valvular disease.

Investigations:
1.Blood tests: In myxomas these typically show the anemia of chronic disease, raised inflammatory markers (erythrocyte sedimentation rate and C-reactive protein) and gamma-globulins.

2. Chest radiograph: The tumor may distort the cardiac silhouette. Sudden cardiac or pericardial enlargement, mediastinal lymphadenopathy or an irregular/ indistinct cardiac border may be seen. Intracardiac calcification may occur in myxomas.

3. Echocardiography: This is usually visible on transthoracicecho, but transoesophageal echocardiography may be required in some cases.

Differential diagnosis: Consider endocarditis and MV disease.

Treatment:
  • Urgent surgical resection of myxomas is required.
  • Avoid the risks of embolisation.
  • Most malignant tumours are treated palliatively, although renal cell tumors invading the IVC may be excised.
  • Palliative chemotherapy may be appropriate for certain tumor types.
Complications: Myxomas may embolise or cause pulmonary oedema due to MV obstruction. Malignant disease may cause tamponade, heart block, arrhythmias and heart failure. Recurrent pericardial effusions are treated with a pericardial window.

Prognosis: Once removed, the prognosis for patients with myxoma is a normal lifespan.

Disease associations:

Myxomas can be familial (Carney’s syndrome or ‘syndrome myxoma’), with autosomal dominant transmission in 10% of cases. This is associated with endocrine hyperactivity, lentigines and myxomas elsewhere in the body. Multiple tumours occur in approximately 50% of familial cases, and are more common in the ventricle. The mean age of presentation of familial cases is 25 years, and for sporadic cases 56 years.

2 comments:

  1. Good day to all am Valeria Miguel Ángel From USA..Texas am so happy sharing this great testimony on here, I was diagnose of Stage IV colon cancer.i was checking for solution in the internet then miraculously i came Across Dr Itua the powerful herbalist that Cure Numerous Diseases such as-Thyroid Cancer,Uterine cancer,Fibroid,Angiopathy, Ataxia,Arthritis,Amyotrophic Lateral Scoliosis,Brain Tumor,Fibromyalgia,Fluoroquinolone ToxicityBladder cancer,Brain cancer,Hiv,Herpes,Esophageal cancer,Gallbladder cancer,Gestational trophoblastic disease,Head and neck cancer,Hodgkin lymphoma
    Intestinal cancer,Kidney cancer,Hpv,Lung cancer,Melanoma,Mesothelioma,Multiple myeloma,Neuroendocrine tumors
    Non-Hodgkin lymphoma,Oral cancer,Ovarian cancer,Sinus cancer,Hepatitis A,B/C,Skin cancer,Soft tissue sarcoma,Pancreative Cancer,Spinal cancer,Stomach cancer,Vaginal cancer,Vulvar cancer,
    Testicular cancer,Tach Diseases,Leukemia,Liver cancer,Throat cancer,
    Syndrome Fibrodysplasia Ossificans ProgresSclerosis,Alzheimer's disease,Chronic Diarrhea,Copd,Parkinson,Als,Adrenocortical carcinoma  Infectious mononucleosis. ,so I contacted him base on the testimonies I?m seeing about him on the internet, I was cured too by him, kindly contact him today through his email he can help you..drituaherbalcenter@gmail.com and his herbal medicines will set you free from any human diseases,all thank to you Dr Itua for your kindly help in my life his Mobile number Whatsapp.+2348149277967

    ReplyDelete
  2. It’s not that I’m horny all the time. Hey, i am looking for an online sexual partner ;) Click on my boobs if you are interested (. )( .)

    ReplyDelete