Cardiac tumors physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

A "tumor plop" (a sound related to movement of the tumor), abnormal heart sounds, or murmur may be heard. These sounds may change when the patient changes position.

Physical Examination

Neck

• Prominent A wave with elevation of JVP may be present.

Heart

Auscultation

Heart Sounds

• Prolapsing of atrial tumor into the mitral valve orifice results in delay in closure of mitral valve producing a loud S1.
• There is a delay in P2, intensity of which depends on the absence or presence of pulmonary hypertension.
• Atrial tumor striking against the endocardial wall may produce an early diastolic sound known as the "tumor plop".
• In some cases S3 and S4 may also be present.

Murmur

• In case of obstruction of mitral valve by the atrial tumor, a diastolic atrial rumble is heard.
• If atrial tumor results in damaging of the mitral valves leading to mitral regurgitation then a systolic murmur is heard at the cardiac apex.
• In case of right atrial tumor, a diastolic rumble due to obstruction of the tricuspid valve and a holosystolic murmur due to tricuspid regurgitation may be present.

Pertinent Syndromes Associated with Cardiac Tumors: Focused Physical Examination

• Familial myxoma: It presents with a variety of features called syndrome myxoma or Carney syndrome, as follows:

• Myxomas in heart, breast, skin, thyroid gland, or neural tissue
• Spotty skin pigmentation such as lentigines (ie, flat brown discoloration of skin), pigmented nevi, or both on the face, especially on the lips, eyelids, conjunctiva, and oral mucosa
• Endocrine tumors may manifest as disorders such as Cushing syndrome. The most common endocrine gland manifestation is an ACTH-independent Cushing's syndrome due to primary pigmented nodular adrenocortical disease (PPNAD).
• Multiple cerebral fusiform aneurysms may also be seen in patients with Carney syndrome

• NAME syndrome: It refers to:

• Nevi,
• Atrial myxoma,
• Myxoid neurofibroma, and
• Ephelides (i.e., freckles tanned macules found on the skin)

• LAMB syndrome: It refers to:

• Lentigines,
• Atrial myxoma, and
• Blue nevi