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. Right atrial myxomas rarely produce symptoms until they have grown to be at least 13 cm (about 5 inches) wide.

Physical Examination

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

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