Myxoma physical examination: Difference between revisions
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==Overview== | ==Overview== | ||
There are no specific physical findings for cardiac myxoma. | There are no specific physical findings for cardiac myxoma. The ascultatory presence of a "tumor plop" (which is caused by the obstruction of the [[mitral valve]] orifice by the tumor) on physical examination is highly suggestive of cardiac myxoma. Common physical examination findings of cardiac myxoma include [[systolic]] or [[diastolic murmurs]] (depending on size, mobility, and location of the tumor). | ||
==Physical Examination== | ==Physical Examination== | ||
[[Physical examination]] of [[patients]] with cardiac myxoma is usually remarkable for:<ref name="pmid433739">{{cite journal |vauthors=Bulkley BH, Hutchins GM |title=Atrial myxomas: a fifty year review |journal=Am. Heart J. |volume=97 |issue=5 |pages=639–43 |year=1979 |pmid=433739 |doi= |url=}}</ref><ref name="pmid9578352">{{cite journal |vauthors=Goswami KC, Shrivastava S, Bahl VK, Saxena A, Manchanda SC, Wasir HS |title=Cardiac myxomas: clinical and echocardiographic profile |journal=Int. J. Cardiol. |volume=63 |issue=3 |pages=251–9 |year=1998 |pmid=9578352 |doi= |url=}}</ref><ref name="pmid12006696">{{cite journal |vauthors=Grebenc ML, Rosado-de-Christenson ML, Green CE, Burke AP, Galvin JR |title=Cardiac myxoma: imaging features in 83 patients |journal=Radiographics |volume=22 |issue=3 |pages=673–89 |year=2002 |pmid=12006696 |doi=10.1148/radiographics.22.3.g02ma02673 |url=}}</ref> | |||
===Skin=== | ===Skin=== | ||
* Examination of the extremities may also reveal signs of an embolic phenomenon | * Examination of the extremities may also reveal signs of an [[embolic]] phenomenon | ||
* Blue discoloration of the skin, especially the fingers ([[Raynaud's phenomenon]]) | * Blue discoloration of the [[skin]], especially the fingers ([[Raynaud's phenomenon]])<ref name="pmid9578352" /> | ||
* [[Clubbing]] - curvature of nails accompanied with soft tissue enlargement of the fingers | * [[Clubbing]] - curvature of nails accompanied with soft tissue enlargement of the [[Finger|fingers]]<ref name="pmid9578352" /> | ||
* [[Swelling]] - any part of the body | * [[Swelling]] - any part of the [[body]] | ||
===Lungs=== | ===Lungs=== | ||
*Chest examination may reveal fine crepitations consistent with pulmonary edema | *[[Chest]] examination may reveal fine [[crepitations]] consistent with [[pulmonary edema]]<ref name="SarkarMadabhavi2015">{{cite journal|last1=Sarkar|first1=Malay|last2=Madabhavi|first2=Irappa|last3=Niranjan|first3=Narasimhalu|last4=Dogra|first4=Megha|title=Auscultation of the respiratory system|journal=Annals of Thoracic Medicine|volume=10|issue=3|year=2015|pages=158|issn=1817-1737|doi=10.4103/1817-1737.160831}}</ref> | ||
===Heart=== | ===Heart=== | ||
====Auscultation==== | ====Auscultation==== | ||
Auscultatory findings are characteristically variable and depend most of the time in body position. Moreover, pericardial friction rub may sometimes be present in patients with right atrial tumors.<ref name="pmid7477198">{{cite journal |vauthors=Reynen K |title=Cardiac myxomas |journal=N. Engl. J. Med. |volume=333 |issue=24 |pages=1610–7 |year=1995 |pmid=7477198 |doi=10.1056/NEJM199512143332407 |url=}}</ref> | Auscultatory findings are characteristically variable and depend most of the time in [[body]] position. Moreover, [[pericardial friction rub]] may sometimes be present in patients with [[Right atrium|right atrial]] [[tumors]].<ref name="pmid7477198">{{cite journal |vauthors=Reynen K |title=Cardiac myxomas |journal=N. Engl. J. Med. |volume=333 |issue=24 |pages=1610–7 |year=1995 |pmid=7477198 |doi=10.1056/NEJM199512143332407 |url=}}</ref> | ||
* A "tumor plop" (a sound related to movement of the tumor) can be heard. This is defined as a protodiastolic murmur, it can be heard 80 to 150 msec after the second heart sound. | * A "[[Tumor cell|tumor]] plop" (a sound related to movement of the [[Tumor cell|tumor]]) can be heard. This is defined as a protodiastolic [[Murmurs|murmur]], it can be heard 80 to 150 msec after the second [[heart]] [[sound]]. | ||
* Abnormal [[heart sounds]], or [[murmurs]] may be heard. | * Abnormal [[heart sounds]], or [[murmurs]] may be heard. | ||
* Sounds may change when the patient changes position. | * Sounds may change when the [[patient]] changes position. | ||
* In patients with left atrial myxomas, S1 is often loud and widely split, because the tumor has caused a delay in the closure of the mitral valve. | * In [[patients]] with [[Left atrium|left atrial]] myxomas, [[S1]] is often loud and widely split, because the [[tumor]] has caused a delay in the closure of the [[mitral valve]]. | ||
* Diastolic murmurs are due to the obstruction of the left or right ventricle. | *[[Diastolic murmurs]] are due to the obstruction of the [[Left ventricle|left]] or [[right ventricle]]. | ||
* Systolic murmurs are related to the narrow closure of the [[atrioventricular valves]]. | *[[Systolic murmurs]] are related to the narrow closure of the [[atrioventricular valves]]. | ||
* In most cases, a common ascultatory finding is the accentuated first heart sound and the loud pulmonary component of the second heart sound. | * In most cases, a common ascultatory finding is the accentuated [[first heart sound]] and the loud [[pulmonary]] component of the [[second heart sound]]. | ||
==References== | ==References== | ||
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Myxoma physical examination On the Web |
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American Roentgen Ray Society Images of Myxoma physical examination |
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Risk calculators and risk factors for Myxoma physical examination |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2]Ahmad Al Maradni, M.D. [3]
Overview
There are no specific physical findings for cardiac myxoma. The ascultatory presence of a "tumor plop" (which is caused by the obstruction of the mitral valve orifice by the tumor) on physical examination is highly suggestive of cardiac myxoma. Common physical examination findings of cardiac myxoma include systolic or diastolic murmurs (depending on size, mobility, and location of the tumor).
Physical Examination
Physical examination of patients with cardiac myxoma is usually remarkable for:[1][2][3]
Skin
- Examination of the extremities may also reveal signs of an embolic phenomenon
- Blue discoloration of the skin, especially the fingers (Raynaud's phenomenon)[2]
- Clubbing - curvature of nails accompanied with soft tissue enlargement of the fingers[2]
- Swelling - any part of the body
Lungs
- Chest examination may reveal fine crepitations consistent with pulmonary edema[4]
Heart
Auscultation
Auscultatory findings are characteristically variable and depend most of the time in body position. Moreover, pericardial friction rub may sometimes be present in patients with right atrial tumors.[5]
- A "tumor plop" (a sound related to movement of the tumor) can be heard. This is defined as a protodiastolic murmur, it can be heard 80 to 150 msec after the second heart sound.
- Abnormal heart sounds, or murmurs may be heard.
- Sounds may change when the patient changes position.
- In patients with left atrial myxomas, S1 is often loud and widely split, because the tumor has caused a delay in the closure of the mitral valve.
- Diastolic murmurs are due to the obstruction of the left or right ventricle.
- Systolic murmurs are related to the narrow closure of the atrioventricular valves.
- In most cases, a common ascultatory finding is the accentuated first heart sound and the loud pulmonary component of the second heart sound.
References
- ↑ Bulkley BH, Hutchins GM (1979). "Atrial myxomas: a fifty year review". Am. Heart J. 97 (5): 639–43. PMID 433739.
- ↑ 2.0 2.1 2.2 Goswami KC, Shrivastava S, Bahl VK, Saxena A, Manchanda SC, Wasir HS (1998). "Cardiac myxomas: clinical and echocardiographic profile". Int. J. Cardiol. 63 (3): 251–9. PMID 9578352.
- ↑ Grebenc ML, Rosado-de-Christenson ML, Green CE, Burke AP, Galvin JR (2002). "Cardiac myxoma: imaging features in 83 patients". Radiographics. 22 (3): 673–89. doi:10.1148/radiographics.22.3.g02ma02673. PMID 12006696.
- ↑ Sarkar, Malay; Madabhavi, Irappa; Niranjan, Narasimhalu; Dogra, Megha (2015). "Auscultation of the respiratory system". Annals of Thoracic Medicine. 10 (3): 158. doi:10.4103/1817-1737.160831. ISSN 1817-1737.
- ↑ Reynen K (1995). "Cardiac myxomas". N. Engl. J. Med. 333 (24): 1610–7. doi:10.1056/NEJM199512143332407. PMID 7477198.