Cardiac tumors physical examination: Difference between revisions
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**Erect posture (sitting upright), and | **Erect posture (sitting upright), and | ||
**Cyanosis of the lips. | **Cyanosis of the lips. | ||
*Pedal Edema | |||
===Vitals=== | ===Vitals=== | ||
Revision as of 10:01, 17 June 2022
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Cardiac tumors physical examination On the Web |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Dheeraj Makkar, M.D.[2]
Overview
The symptoms may be associated with cardiac conditions such as valve dysfunction, pericardial effusion with tamponade, intracardiac blood flow blockage, arrhythmia, and congestive heart failure.
- A large majority of cardiac tumors do not produce symptoms and are discovered incidentally.
- The clinical signs of the tumor vary on its size, anatomical site, rate of growth, and potential complications.
Physical Examination
General Examination
- In patients with pulmonary congestion[1]
- Confusion, agitation, and irritability may be present,
- Profuse perspiration, cold extremities,
- Erect posture (sitting upright), and
- Cyanosis of the lips.
- Pedal Edema
Vitals
- Blood pressure
- Hypertension mainly. Hypotension in case of cardiogenic shock due to obstruction.
- Respiratory rate
- Tachypnea, gasping for breath in case of pulmonary congestion
- Pulse
- Tachycardia in shock
- Regularly Irregular pulse in Atrial Fibrillation
- Bradycardia in AV Block
Neck
- Prominent A wave with elevation of JVP may be present.
- A waves may be absent if the tumor occurs with atrial fibrillation.
- Prominent accessory muscles of respiration
Heart
Auscultation
Respiratory Findings
- Fine crackles are audible bilaterally at the pulmonary bases and progress apically as the edema develops.
- Signs could also include rhonchi and wheezing.
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" and the S1 may be split.
- 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.
Gastrointestinal System
- Right-sided heart failure may be accompanied with painful hepatomegaly, which may progress to hepatic fibrosis and hepatic cirrhosis in persistent congestion.
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)[2]
- LAMB syndrome: It refers to:
- Lentigines,
- Atrial myxoma, and
- Blue nevi[2]
References
- ↑ Ostrowski S, Marcinkiewicz A, Kośmider A, Jaszewski R (2014). "Sarcomas of the heart as a difficult interdisciplinary problem". Arch Med Sci. 10 (1): 135–48. doi:10.5114/aoms.2014.40741. PMC 3953983. PMID 24701226.
- ↑ 2.0 2.1 Lee E, Mahani MG, Lu JC, Dorfman AL, Srinivasan A, Agarwal PP (2018). "Primary cardiac tumors associated with genetic syndromes: a comprehensive review". Pediatr Radiol. 48 (2): 156–164. doi:10.1007/s00247-017-4027-2. PMID 29214333.