Myxoma history and symptoms: Difference between revisions
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{{Myxoma}} | {{Myxoma}} | ||
{{CMG}}; | {{CMG}}; {{AE}} {{S.G.}} {{MV}} {{CZ}} {{AAM}} | ||
==Overview== | ==Overview== | ||
There are no hallmark findings in cardiac myxoma. However, clinical features of cardiac myxoma are determined by tumor location, size and mobility. | There are no hallmark findings in cardiac myxoma. However, [[clinical]] features of cardiac myxoma are determined by [[Tumor cell|tumor]] location, size and [[mobility]]. [[Symptom|Symptoms]] may occur at any time, but most often they tend to occur with changes in [[Human body|body]] position. A positive history of [[systemic]] [[embolism]] and [[heart failure]] may be suggestive of cardiac myxoma. The most common [[Symptom|symptoms]] of cardiac myxoma include [[chest pain]], [[syncope]], and [[dyspnea on exertion]]. About 20% of cardiac myxomas are [[asymptomatic]] at the time of [[diagnosis]]. | ||
==History== | ==History== | ||
* Onset, duration and progression of symptoms | * Obtaining the history is an important aspect of making a diagnosis of cardiac myxoma. Complete history will help to rule out, [[familial]] or multiple myxoma forms and also provide correct [[therapy]]. Cardiac myxoma [[patients]] usually have an acute onset with [[Complication (medicine)|complications]], such as [[stroke]].<ref name="pmid1434856">{{cite journal |vauthors=Tazelaar HD, Locke TJ, McGregor CG |title=Pathology of surgically excised primary cardiac tumors |journal=Mayo Clin. Proc. |volume=67 |issue=10 |pages=957–65 |year=1992 |pmid=1434856 |doi= |url=}}</ref> | ||
* Associated symptoms ([[dyspnea]], [[orthopnea]], [[pulmonary edema]]) | * Therefore, the [[patient]] interview may result difficult. In such cases, history from the caregivers or the family members may need to be obtained. Specific histories about the [[Symptom|symptoms]] (duration, onset, progression) or associated [[Symptom|symptoms]] may be useful.<ref name="pmid18350919">{{cite journal |vauthors=Vaideeswar P, Butany JW |title=Benign cardiac tumors of the [[pluripotent]] [[mesenchyme]] |journal=Semin Diagn Pathol |volume=25 |issue=1 |pages=20–8 |year=2008 |pmid=18350919 |doi= |url=}}</ref> | ||
* History of [[hyperpigmentation of the skin]] or endocrine overactivity | * Specific areas of focus when obtaining the history, are outlined below: | ||
* Symptoms of heart failure | **Onset, duration and progression of [[Symptom|symptoms]] | ||
* History of cerebral embolism | **Associated [[Symptom|symptoms]] ([[dyspnea]], [[orthopnea]], [[pulmonary edema]]) | ||
**History of [[hyperpigmentation]] of the [[skin]] or [[endocrine]] overactivity | |||
**[[Symptom|Symptoms]] of [[heart failure]] | |||
**History of [[cerebral embolism]] | |||
== Common Symptoms== | == Common Symptoms== | ||
Symptoms associated with cardiac myxomas are typically due to the effect of the mass of the tumor obstructing the normal blood flow within the heart chambers. Left atrial myxoma symptoms may mimic [[mitral stenosis]] | [[Symptom|Symptoms]] associated with cardiac myxomas are typically due to the effect of the mass of the [[Tumor cell|tumor]] obstructing the normal [[blood]] flow within the [[heart]] chambers. [[Left atrium|Left atrial]] myxoma [[Symptom|symptoms]] may mimic [[mitral stenosis|mitral stenosis,]] while [[Right atrium|right atrial]] myxomas rarely produce [[Symptom|symptoms]] until they have grown to be at least 13 cm wide. General [[Symptom|symptoms]] may also mimic those of [[infective endocarditis]].<ref name="pmid20834208">{{cite journal |vauthors=Ramchandani M |title=Less invasive surgery for cardiac tumors |journal=Methodist Debakey Cardiovasc J |volume=6 |issue=3 |pages=27–31 |year=2010 |pmid=20834208 |doi= |url=}}</ref> | ||
Clinical features can be categorized as: | [[Clinical]] features can be categorized as:<ref name="ThyagarajanKumar2017">{{cite journal|last1=Thyagarajan|first1=Braghadheeswar|last2=Kumar|first2=Monisha Priyadarshini|last3=Patel|first3=Shil|last4=Agrawal|first4=Abhinav|title=Extracardiac manifestations of atrial myxomas|journal=Journal of the Saudi Heart Association|volume=29|issue=1|year=2017|pages=37–43|issn=10167315|doi=10.1016/j.jsha.2016.07.003}}</ref><ref name="TetsukaIkeguchi2015">{{cite journal|last1=Tetsuka|first1=Syuichi|last2=Ikeguchi|first2=Kunihiko|title=Prevention of Cerebral Embolism Progression by Emergency Surgery of the Left Atrial Myxoma|journal=Case Reports in Medicine|volume=2015|year=2015|pages=1–4|issn=1687-9627|doi=10.1155/2015/151802}}</ref><ref name="GrebencRosado de Christenson2000">{{cite journal|last1=Grebenc|first1=Mary L.|last2=Rosado de Christenson|first2=Melissa L.|last3=Burke|first3=Allen P.|last4=Green|first4=Curtis E.|last5=Galvin|first5=Jeffrey R.|title=Primary Cardiac and Pericardial Neoplasms: Radiologic-Pathologic Correlation|journal=RadioGraphics|volume=20|issue=4|year=2000|pages=1073–1103|issn=0271-5333|doi=10.1148/radiographics.20.4.g00jl081073}}</ref> | ||
'''Valvular obstruction''' | '''[[Valvular]] obstruction''' | ||
*Left sided: dyspnea, orthopnea, pulmonary edema | *Left sided: [[dyspnea]], [[orthopnea]], [[pulmonary edema]] | ||
*Right sided: symptoms of right heart failure | *Right sided: symptoms of [[right heart failure]] | ||
'''Embolic event''' | '''[[Embolic]] event''' | ||
*Distribution will depend on location of tumor | *Distribution will depend on location of tumor | ||
*Most are left sided, and therefore most are systemic (brain or extremities) | *Most are left sided, and therefore most are systemic ([[Cerebral embolism|brain]] or [[extremities]]) | ||
'''Constitutional symptoms''' | '''Constitutional symptoms''' | ||
*Weight loss, fatigue, weakness | *[[Weight loss]], [[fatigue]], [[weakness]] | ||
*May resemble infective endocarditis (fever, arthralgia, lethargy) | *May resemble [[infective endocarditis]] ([[fever]], [[arthralgia]], [[lethargy]]) | ||
== Less Common Symptoms== | == Less Common Symptoms== | ||
Less common symptoms may include: | Less common symptoms may include:<ref name="pmid20666072">{{cite journal |vauthors=Leonard S, Ryan J |title=A heavy heart; A massive right atrial myxoma causing fatigue and shortness of breath |journal=Ir Med J |volume=103 |issue=3 |pages=83–4 |date=March 2010 |pmid=20666072 |doi= |url=}}</ref><ref name="pmid28090362">{{cite journal |vauthors=Fakhari S, Bilehjani E |title=A Large Left Ventricle Myxoma: Presenting with Epigastric Pain and Weight Loss |journal=Case Rep Cardiol |volume=2016 |issue= |pages=9018249 |date=2016 |pmid=28090362 |pmc=5206423 |doi=10.1155/2016/9018249 |url=}}</ref> | ||
* [[Shortness of breath]] | *[[Shortness of breath with activity]] | ||
* [[Platypnea]] - difficulty breathing in the upright position with relief in the supine position | * [[Platypnea]] - difficulty breathing in the upright position with relief in the [[supine position]] | ||
* [[Paroxysmal nocturnal dyspnea]] - breathing difficulty when asleep | * [[Paroxysmal nocturnal dyspnea]] - breathing difficulty when asleep | ||
* [[Dizziness]] | * [[Dizziness]] | ||
* [[Fainting]] | * [[Fainting]] | ||
* [[Palpitations]] - sensation of feeling your heart beat | * [[Palpitations]] - sensation of feeling your heart beat | ||
* [[Chest pain]] or tightness | * [[Chest pain]] or [[Chest tightness|tightness]] | ||
* [[Sudden Death]] (in which case the disease is an autopsy finding) | * [[Sudden Death]] (in which case the disease is an [[autopsy]] finding) | ||
==References== | ==References== | ||
Latest revision as of 14:28, 16 April 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sogand Goudarzi, MD [2] Maria Fernanda Villarreal, M.D. [3] Cafer Zorkun, M.D., Ph.D. [4] Ahmad Al Maradni, M.D. [5]
Overview
There are no hallmark findings in cardiac myxoma. However, clinical features of cardiac myxoma are determined by tumor location, size and mobility. Symptoms may occur at any time, but most often they tend to occur with changes in body position. A positive history of systemic embolism and heart failure may be suggestive of cardiac myxoma. The most common symptoms of cardiac myxoma include chest pain, syncope, and dyspnea on exertion. About 20% of cardiac myxomas are asymptomatic at the time of diagnosis.
History
- Obtaining the history is an important aspect of making a diagnosis of cardiac myxoma. Complete history will help to rule out, familial or multiple myxoma forms and also provide correct therapy. Cardiac myxoma patients usually have an acute onset with complications, such as stroke.[1]
- Therefore, the patient interview may result difficult. In such cases, history from the caregivers or the family members may need to be obtained. Specific histories about the symptoms (duration, onset, progression) or associated symptoms may be useful.[2]
- Specific areas of focus when obtaining the history, are outlined below:
- Onset, duration and progression of symptoms
- Associated symptoms (dyspnea, orthopnea, pulmonary edema)
- History of hyperpigmentation of the skin or endocrine overactivity
- Symptoms of heart failure
- History of cerebral embolism
Common Symptoms
Symptoms associated with cardiac myxomas are typically due to the effect of the mass of the tumor obstructing the normal blood flow within the heart chambers. Left atrial myxoma symptoms may mimic mitral stenosis, while right atrial myxomas rarely produce symptoms until they have grown to be at least 13 cm wide. General symptoms may also mimic those of infective endocarditis.[3]
Clinical features can be categorized as:[4][5][6]
Valvular obstruction
- Left sided: dyspnea, orthopnea, pulmonary edema
- Right sided: symptoms of right heart failure
Embolic event
- Distribution will depend on location of tumor
- Most are left sided, and therefore most are systemic (brain or extremities)
Constitutional symptoms
- Weight loss, fatigue, weakness
- May resemble infective endocarditis (fever, arthralgia, lethargy)
Less Common Symptoms
Less common symptoms may include:[7][8]
- Shortness of breath with activity
- Platypnea - difficulty breathing in the upright position with relief in the supine position
- Paroxysmal nocturnal dyspnea - breathing difficulty when asleep
- Dizziness
- Fainting
- Palpitations - sensation of feeling your heart beat
- Chest pain or tightness
- Sudden Death (in which case the disease is an autopsy finding)
References
- ↑ Tazelaar HD, Locke TJ, McGregor CG (1992). "Pathology of surgically excised primary cardiac tumors". Mayo Clin. Proc. 67 (10): 957–65. PMID 1434856.
- ↑ Vaideeswar P, Butany JW (2008). "Benign cardiac tumors of the pluripotent mesenchyme". Semin Diagn Pathol. 25 (1): 20–8. PMID 18350919.
- ↑ Ramchandani M (2010). "Less invasive surgery for cardiac tumors". Methodist Debakey Cardiovasc J. 6 (3): 27–31. PMID 20834208.
- ↑ Thyagarajan, Braghadheeswar; Kumar, Monisha Priyadarshini; Patel, Shil; Agrawal, Abhinav (2017). "Extracardiac manifestations of atrial myxomas". Journal of the Saudi Heart Association. 29 (1): 37–43. doi:10.1016/j.jsha.2016.07.003. ISSN 1016-7315.
- ↑ Tetsuka, Syuichi; Ikeguchi, Kunihiko (2015). "Prevention of Cerebral Embolism Progression by Emergency Surgery of the Left Atrial Myxoma". Case Reports in Medicine. 2015: 1–4. doi:10.1155/2015/151802. ISSN 1687-9627.
- ↑ Grebenc, Mary L.; Rosado de Christenson, Melissa L.; Burke, Allen P.; Green, Curtis E.; Galvin, Jeffrey R. (2000). "Primary Cardiac and Pericardial Neoplasms: Radiologic-Pathologic Correlation". RadioGraphics. 20 (4): 1073–1103. doi:10.1148/radiographics.20.4.g00jl081073. ISSN 0271-5333.
- ↑ Leonard S, Ryan J (March 2010). "A heavy heart; A massive right atrial myxoma causing fatigue and shortness of breath". Ir Med J. 103 (3): 83–4. PMID 20666072.
- ↑ Fakhari S, Bilehjani E (2016). "A Large Left Ventricle Myxoma: Presenting with Epigastric Pain and Weight Loss". Case Rep Cardiol. 2016: 9018249. doi:10.1155/2016/9018249. PMC 5206423. PMID 28090362.