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KEY FEATURES

ESSENTIALS OF DIAGNOSIS

  • Positive imaging study for characteristic cardiac masses

  • Positive biopsy of cardiac masses

GENERAL CONSIDERATIONS

  • Primary tumors of the heart (excluding myxomas) are rare (see Left Atrial Myxoma)

  • Metastatic tumors to the heart occur 30 times more frequently than primary tumors

  • Most primary cardiac tumors are benign:

    • – Fibromas

    • – Lipomas

    • – Papillary fibroelastomas

    • – Rhabdomyomas

  • Malignant tumors include:

    • – Lymphomas

    • – Sarcomas

  • Most benign cardiac tumors occur in children:

    • – Fibromas

    • – Hamartomas

    • – Hemangiomas

    • – Rhabdomyomas

  • Symptoms and signs are determined by tumor location rather than histology

CLINICAL PRESENTATION

SYMPTOMS AND SIGNS

  • Symptoms of heart failure, such as dyspnea

  • Palpitation due to arrhythmias

  • Constitutional symptoms:

    • – Weight loss

    • – Fatigue

    • – Fever

  • Chest pain

  • Asymptomatic with incidental finding on an imaging study

PHYSICAL EXAM FINDINGS

  • Elevated jugular venous pressure with right heart tumors

  • Signs of congestive heart failure

DIFFERENTIAL DIAGNOSIS

  • Metastatic tumors

  • Thrombus

  • Nonbacterial thrombotic endocarditis

  • Vegetations from infective endocarditis

  • Flail or prolapsing valve leaflets

  • Giant aneurysm of the coronary artery

  • Pericardial cyst

  • Diaphragmatic hernia

  • Lipomatous cardiac infiltration

  • Normal anatomic variants:

    • – Chiari network

    • – Eustachian valve

    • – Septum spurium

    • – Thebesian valve

    • – Left superior pulmonary vein

    • – Atrial septal aneurysm

DIAGNOSTIC EVALUATION

LABORATORY TESTS

  • CBC: anemia, leukocytosis

  • Elevated erythrocyte sedimentation rate

ELECTROCARDIOGRAPHY

  • Conduction abnormalities

  • Arrhythmias

IMAGING STUDIES

  • Echocardiography:

    • – Excellent for endocardial tumors

    • – Good for myocardial tumors

    • – Poor for pericardial tumors

  • CT and MRI:

    • – Excellent for paracardiac tumors and can often distinguish tissue type, such as lipoma

    • – Positron emission tomography (PET) imaging alone or combined with CT or MRI can help distinguish tumors from other masses and separate benign from malignant tumors

DIAGNOSTIC PROCEDURES

  • Coronary angiography may be indicated before surgery

  • Cardiac biopsy via catheter or limited surgery may be required

TREATMENT

CARDIOLOGY REFERRAL

  • Suspected cardiac tumor

  • Heart failure

  • Chest pain

  • Arrhythmias

HOSPITALIZATION CRITERIA

  • Heart failure

  • Hemodynamic compromise

  • Need for procedure or surgery

MEDICATIONS

  • Pharmacologic therapy is adjunctive for specific tumors

THERAPEUTIC PROCEDURES

  • Radiation therapy is adjunctive for specific situations

SURGERY

  • Surgery can be curative or can be used to reduce symptoms

  • Cardiac transplantation is an alternative for unresectable tumors

MONITORING

  • ECG monitoring in hospital as appropriate

ONGOING MANAGEMENT

HOSPITAL DISCHARGE CRITERIA

  • Resolution of problem

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