Tumors of the heart


 * Primary heart tumors are relatively rare.
 * Secondary heart tumors are much more common, affecting up to 20% of patients dying from generalized cancer.

Division of the tumors
We distinguish tumors:
 * 1) primary;
 * 2) benign (myxoma, fibroma, neurofibroma, lipoma, hemangioma, lymphangioma, rhabdomyoma, teratoma);
 * 3) malignant (angiosarcoma, fibrosarcoma, rhabdomyosarcoma, malignant mesothelioma);
 * 4) secondary (metastases – malignant tumors of the breast, lungs, etc.).

Even benign tumors can cause serious hemodynamic deficit!

Primary heart tumors
Primary heart tumors are significantly less common than secondary tumors.

Benign tumors
Benign heart tumors include:

Papillary fibroelastoma
A warty or tuft-like formation on the heart valves.

Myxoma of the heart
In 80% of cases it is located in the left atrium, in 15% in the right atrium, in 5% in the left or right ventricle.


 * Clinical symptoms


 * in case of embolization: ischemia of the organs supplied by the embolized artery;
 * in case of obstruction of the mitral orifice: shortness of breath, increased fatigue, cough, hemoptysis, pulmonary edema;
 * in case of obstruction of the tricuspid orifice: symptoms of right-sided heart failure

Cardiac myxoma can be accompanied by a number of non-specific symptoms.


 * Diagnostics
 * Anamnesis.
 * Physical exam.
 * Echocardiography.


 * Therapy


 * surgical removal,
 * echocardiographic monitoring.


 * Carney syndrome

= complex myxoma syndrome.
 * This is a rare syndrome in which cardiac myxoma is associated with:
 * multiple pigment nevi,
 * adrenocortical hyperplasia,
 * pituitary tumors,
 * multiple breast fibroadenomas,
 * Sertoli tumor of the testicles,
 * cutaneous myxomas

Rhabdomyoma
See the Rhabdomyoma page for more detailed information.

Sarcomas

 * Angiosarcoma, rhabdomyosarcoma (fibrosarcoma, liposarcoma, osteosarcoma),
 * occur at any age,
 * most often in the right atrium,
 * clinically: manifestations of heart failure, arrhythmia, pain in the precordium, pericardial effusion, cardiac tamponade, sudden cardiac death; embolization (of tumor masses, thrombi; often to the CNS), pulmonary edema, syncope (for tumors in the left atrium); extracardiac metastases (lungs, mediastinum, spine, etc.); prognosis very unfavorable (approx. 3 months),
 * diagnosis: weight loss, club fingers, heart failure, arrhythmia, pericardial friction murmur, diastolic tip murmur / regurgitation systolic murmur; hl. ECHO, CT and MRI,
 * therapy: surgical removal, but usually only palliative surgery.

Secondary heart tumors
This is a metastatic involvement of the heart:


 * no tumor (with the exception of malignant melanoma) metastasizes exclusively to the heart,
 * heart metastases: malignant melanoma, bronchogenic carcinoma, breast cancer,
 * clinically: acute pericarditis, cardiac tamponade, rapid enlargement of the cardiac shadow, arrhythmia incl. atrioventricular blocks, rapid development of heart failure (however, 90% of metastases are clinically silent),
 * therapy: hl. palliation: pericardiocentesis for effusion, radiotherapy, chemotherapy.

Related articles

 * Tumors of the mediastinum

Used literature

 * KLENER, Pavel, et al. Vnitřní lékařství. 3. vydání. Praha : Galén, 2006. 1158 s.  ISBN 80-7262-430-X.
 * VANĚK, Ivan, et al. Kardiovaskulární chirurgie. 1. vydání. Praha : Karolinum, 2003. 236 s.  ISBN 8024605236.

Categories: Internal Medicine, Cardiology, Pathology, Oncology, Surgery