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Curable by surgery
Relative incidence of benign heart tumors
% of Group
TUMOR Adults Children Infants
Myxoma 46 15 0
Lipoma 21 0 0
Papillary fibroelastoma 16 0 0
Rhabdomyoma 2 46 65
Fibroma 3 15 12
Hemangioma 5 5 4
Teratoma 1 13 18
Mesothelioma of AV node 3 4 2
Granular cell tumor 1 0 0
Neurofibroma 1 1 0
Lymphangioma 1 0 0
Hamartoma 0 1 0
Relative incidence of primary malignant heart tumors
% of Group
TUMOR TYPE Adults Children Infants
Angiosarcoma 33 0 0
Rhabdomyosarcoma 21 33 66
Mesothelioma 16 0 0
Fibrosarcoma 11 11 33
Malignant lymphoma 6 0 0
Extraskeletal osteosarcoma 4 0 0
Thymoma 3 0 0
Neurogeic sarcoma 3 11 0
Leiomyosarcoma 1 0 0
Liposarcoma 1 0 0
Synovial sarcoma 1 0 0
Malignant teratoma 0 44 0
Clinical Presentation
Sporadic vs familial
Clinical Presentation
Diagnosis:
Clinical:
Symptoms due to mechanical
interference with cardiac function
Arrhythmias
Conduction disturbances
Abnormality of cardiac silhouette on CXR
Cardiac Lipomas
If subepicardial
Compression of the heart
Pericardial effusion
If subendocardial
With intracavitary extension, may
produce symptoms characteristic of their
location
Histologic types:
Angiosarcomas most common
Rhabdomyosarcoma
Fibrosarcoma
Osteosarcoma
Location:
1. Pericardium most common
2. Myocardium
3. Rarely, endocardium and cardiac valves
Cardiac Metastases
Clinical presentation:
Clinical presentation:
2. Restrictive cardiomyopathy
3. Autonomic Neuropathy
Clinical:
Bradycardia
Hypotension
ECG: NSSTTWC, ectopic rhythm
MVP
Decreased exercise capacity
Heart failure, worsened or precipitated by
feeding
Malnutrition & Vitamin Deficiency
Clinical:
a) Generalized malnutrition
b) Peripheral neuropathy
c) Glossitis
d) Anemia
Malnutrition & Vitamin Deficiency
Diagnostic criteria:
a) Clinical features
Dependent edema
Low peripheral vascular resistance,
decreased minimum BP, increased pulse
pressure
Hyperkinetic circulatory state (mid-systolic
murmur and S3)
Enlarged heart
T-wave changes on ECG: inverted,
diphasic, depressed
Peripheral neuritis
Dietary deficiency for at least 3 months or
chronic alcoholism
Malnutrition & Vitamin Deficiency
Diagnostic criteria:
Increased prevalence of
Hypertension
Glucose intolerance
Atherosclerotic coronary artery disease
Treatment:
Digitalis
Sodium restriction
Diuretics
Thyroid Disease
Essentials of Diagnosis:
1. Low TSH levels
2. Increased T3, T4, iodine uptake
General Considerations:
1. Increased levels of thyroid hormone
hyperdynamic CVS
Increased cardiac output, contractility;
tachycardia
2. Decreased SVR
Hyperthyroidism
Physical Examination:
Diagnostic Studies:
2. Echocardiography hypercontractility,
increased LV mass & hypertrophy
Initial Diagnosis:
1. Atrial arrhythmias
2. Cardiac enlargement
3. Ventricular failure
4. s/sx of hyperthyroidism
Definite Diagnosis:
1. (+) signs and symptoms
2. Biochemical evidence of hyperthyroidism
3. Reversal of findings after treatment
Hyperthyroidism
Treatment:
Directed at improving s/sx, reducing the
demands to the heart
1. Anti-thyroid drugs
2. Thyroid ablation
3. Steroids hydrocortisone 50-100 mg q 6-
8 hours
4. Beta blockers if without CHF Propanolol
20-30 mg 4x/day
5. Digitalis
6. Anti-coagulation
Hypothyroidism
Essentials of Diagnosis:
Increased TSH
Low T3, T4, FTI
General Considerations:
Given to any form of TH deficiency
Myxedema TH deficiency with profound
hypothermia, hypoventilation,
hypotension, CNS signs (coma)
Associated with accelerated athero-
sclerosis
Angina uncommon due to decreased
metabolic demand
Hypothyroidism
Clinical Findings:
Clinical Findings:
Diagnostic Studies:
1. ECG
sinus bradycardia
prolonged PR & QT interval
low voltage complexes
flattened or inverted T waves
Atrial, ventricular or interventricular delay
Diagnostic Studies:
3. Laboratory findings
Initial Diagnosis:
1. Pericardial effusion or decreased
contractile performance
2. Clinical suspicion of hypothyroidism
Definite Diagnosis:
1. Clinical findings
2. Biochemical evidence of hypothyroidism
3. Reversal of abnormalities after treatment
with thyroid hormone
Hypothyroidism
Treatment:
Gastrointestinal carcinoids
Almost exclusively in the right side
Occur only with hepatic metastases
substance responsible for the cardiac
lesions inactivated by passage through
liver and lungs
Malignant Carcinoid
Clinical syndrome:
Pericarditis
Most common cause of clinically
apparent disease
Found by echocardiography in 10-50% of
patients, particularly those with sub-
cutaneous nodules
Usually benign course but may progress
to cardiac tamponade or constrictive
pericarditis
Rheumatoid Arthritis
Coronary arteritis
20% of cases; rarely results in angina or MI
Cardiac valves
Mitral or aortic regurgitation
Inflammation and granuloma formation
Myocarditis
Rarely result in cardiac dysfunction
Pericardial fluid
Exudate, dec. conc. complements, dec.
Glucose, elevated cholesterol
Rheumatoid Arthritis
Treatment:
Treat underlying RA
Glucocorticoids
Pericardiectomy
Systemic Lupus Erythematosus
Pericarditis
2/3 of patients
Benign course
Rarely tamponade or constriction
Myocarditis
Seen in autopsy in up to 80%
Only 20% clinically detected
Parallels the activity of the disease
Seldom results to clinical heart failure,
unless associated with hypertension
Systemic Lupus Erythematosus
Thrombotic Disease