Cardiac tumors history and symptoms
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Varun Kumar, M.B.B.S., Dheeraj Makkar, M.D.[2]
Overview
Cardiac tumors present with a wide variety of symptoms. Many patients remain asymptomatic, and the tumor is an incidental finding. Some patients may present with symptoms of mimicking those of valve abnormalities such as mitral stenosis. Patients may also present with rhythm disturbances, endocarditis or even heart failure.
History and Symptoms
- In general, tumors might manifest in one of three ways:
- Systemic symptoms include constitutional symptoms(fever, arthralgias, weight loss, weariness) and paraneoplastic disorders (PCTs).
- Cardiovascular: mass effect compromising myocardial function or blood flow, causing arrhythmias, obstruction of heart valves leading to regurgitation, or pericardial effusion with or without tamponade. Primary symptoms include breathlessness, chest pain, presyncope, and syncope.
- Thromboembolic: lung and systemic thromboembolic condition resulting from the tumor.[1]
Cardiovascular symptoms
Left Atrial Tumors
Atrial myxomas which is benign, is the most common primary tumor of left atrium. However, other metastatic tumors may have a similar presentation[2]. Left atrial tumors may obstruct blood flow across the mitral valve into the left ventricle simulating mitral stenosis. These patients may also develop the following symptoms of pulmonary hypertension and heart failure:
- Orthopnoea
- Shortness of breath with activity
- Chest pain
- Cough with hemoptysis
- Dizziness
- Fainting
- Palpitations
- Pedal edema
- Dizziness
Patients may also give a history of worsening of symptoms in certain positions. Indeed, the patient may develop platypnea, whereby the symptoms are worse when sitting up, and are relieved when lying flat.
Right Atrial Tumors
Tumors in the lumen of right atria may mechanically obstruct the tricuspid valve similar to the mechanism by which a left atrial myxoma obstructs the mitral valve. This results in reduced blood flow across the tricuspid valve which in turn causes symptoms of right heart failure such as:
- Pedal edema
- Abdominal distension and the presence of ascites
Right Ventricular Tumors
Tumors in right ventricle are usually intra-luminal resulting in reduced right ventricular filling or outflow. The symptoms in patients with right ventricular tumors mimic pulmonary stenosis or tricuspid valve insufficiency. These patients may ultimately progress to right heart failure.
Left Ventricular Tumors
Left ventricular tumors are either intra-luminal (in the cavity the left ventricle) or intra-mural (in the wall of the left ventricle). The tumors within the cavity of left ventricle may obstruct left ventricular outflow mimicking aortic stenosis. The patients with intra-mural tumors may present with cardiac conduction abnormalities and arrhythmias. Left ventricular failure may develop in these patients if left untreated. Patients may present with symptoms of:
Symptoms Due To Metastasis
Cardiac tumors may metastasize to the pericardium in may cause arrhythmias, pericardial effusion or pericardial tamponade.
Symptoms Related to Embolization
Cardiac tumors can cause systemic embolization or pulmonary embolism. Neurological complications were observed in 12% of patients in a series involving 74 patients with atrial myxoma[3]. In another series which included 323 patients with cardiac tumors, 9.7% of patients experienced stroke, 9.3% experienced transient ischemic attack and 6% of patients experienced ischemia or infarction of other organs including pulmonary embolism[4].
Symptoms related to embolization vary with organs involved:
Cerebral Embolization
The symptoms depend upon the site of ischemic insult:
- Weakness of limbs
- Sensory abnormalities
- Ataxia
- Memory deficits
- Confusion
- Altered breathing and heart rate
- Aphasia
- Apraxia
- Altered smell, taste, hearing, or vision
- Seizure
- Dizziness
- Loss of consciousness
Retinal Artery Embolization
- Retinal artery embolization is associated with visual loss.
Pulmonary Embolism
Pulmonary embolism more common with right heart tumors.
Coronary Artery Embolization
Coronary artery embolization is associated with signs and symptoms of cardiac ischemia and potentially myocardial infarction:
Constitutional Symptoms
- Weight loss
- Decreased appetite
- Fever
- Fatigue
References
- ↑ Tyebally S, Chen D, Bhattacharyya S, Mughrabi A, Hussain Z, Manisty C; et al. (2020). "Cardiac Tumors: JACC CardioOncology State-of-the-Art Review". JACC CardioOncol. 2 (2): 293–311. doi:10.1016/j.jaccao.2020.05.009. PMC 8352246 Check
|pmc=value (help). PMID 34396236 Check|pmid=value (help). - ↑ Kumar S, Chaudhry MA, Khan I, Duthie DJ, Lindsay S, Kaul P (2004). "Metastatic left atrial synovial sarcoma mimicking a myxoma". J Thorac Cardiovasc Surg. 128 (5): 756–8. doi:10.1016/j.jtcvs.2004.03.037. PMID 15514606.
- ↑ Lee VH, Connolly HM, Brown RD (2007). "Central nervous system manifestations of cardiac myxoma". Arch Neurol. 64 (8): 1115–20. doi:10.1001/archneur.64.8.1115. PMID 17698701.
- ↑ Elbardissi AW, Dearani JA, Daly RC, Mullany CJ, Orszulak TA, Puga FJ; et al. (2009). "Embolic potential of cardiac tumors and outcome after resection: a case-control study". Stroke. 40 (1): 156–62. doi:10.1161/STROKEAHA.108.525709. PMID 18948602.