primary cardiac tumor
Introduction
Introduction to primary cardiac tumors About 70% of primary cardiac tumors are benign, and most cases can be cured. More than half of benign cardiac tumors are cardiac myxoma, and other benign cardiac tumors include lipoma, hemangioma, fibroid, hamartoma and teratoma. Myxoma is most common in the left atrium, accounting for about 75% of the total number of cardiac myxoma, followed by right atrial myxoma, accounting for about 20%, ventricular myxoma and multiple myxoma are rare. basic knowledge The proportion of illness: 0.001% Susceptible people: mostly in adults Mode of infection: non-infectious Complications: ascites anemia edema coma
Cause
Primary cardiac tumor cause
The cause of primary cardiac cancer is unknown, but about 70% of them are benign tumors. More than half of benign cardiac tumors are cardiac myxoma. Other benign cardiac tumors still have lipoma, hemangioma, fibroid, hamartoma. And teratomas and so on.
Prevention
Primary cardiac tumor prevention
There are no effective preventive measures for this disease. The diagnosis and treatment of primary cardiac tumors have been greatly developed, but due to the relatively low incidence of cardiac tumors, many cases of cardiac malignant tumors have been reported for many years, and various opinions on diagnosis and treatment have been different. Sexual cardiac tumors are rare in clinical practice, with an incidence rate of 0.002% to 0.3%, of which 25% are malignant tumors. Primary cardiac malignancies can occur at any age (3 months to 70 years), mostly in adults, and 75% in 49. Under the age of less than 10% of infants and young children, cardiac sarcoma is the most common, accounting for 20% of all cardiac tumors, accounting for 80% of cardiac malignancies. Cardiac sarcoma is poorly differentiated, generally can be divided into spindle cell sarcoma (mucinous sarcoma, fibrosarcoma) ), angiosarcoma and rhabdomyosarcoma, three types of tissue, angiosarcoma and rhabdomyosarcoma occur in men, other pathological types of primary malignant tumors can be seen in isolated cases, such as malignant teratoma, hamartoma, melanin Tumors, etc.
Complication
Primary cardiac tumor complications Complications, ascites anemia, edema, coma
Long-term left atrial pressure rise, accompanied by increased pulmonary pressure and right heart failure, patients with jugular vein filling, anger, lower extremity edema, hepatosplenomegaly, and even ascites sign, tumor thrombus shedding into the systemic circulation can cause brain , kidney, mesenteric and lower extremity vascular embolism, in addition, about half of patients may have symptoms such as hypothermia, mild anemia, weight loss, and poor appetite. These symptoms may be related to hemorrhage, degeneration and tissue necrosis in the tumor or allergic reaction of the body to myxoma. related.
Among them, the most common complications after intracardiac myxoma are:
1 heart rhythm disorder and atrioventricular bundle conduction block;
2 systemic circulation embolism: often caused by the shedding of tumor fragments, the main blood vessel embolism in the brain can cause hypoxia, edema and necrosis of the brain tissue, the patient is unconscious or even dead, and other important organs of the body are embolized.
Symptom
Symptoms of primary cardiac tumors Common symptoms Heart "stealing" feeling low fever, dizziness, palpitations, hemoptysis, hemorrhagic pain, tricuspid stenosis
Mainly manifested as nausea after tiring, shortness of breath, chest tightness, similar to the symptoms of mitral stenosis, the disease progresses faster, eventually heart failure, dizziness or transient fainting are caused by the tumor blocking the mitral valve orifice Insufficient cerebral blood supply, patients rest or change position, the above symptoms can be alleviated, the tumor suddenly occludes the mitral valve, which can cause sudden increase of left atrial and pulmonary vein pressure and produce acute left heart failure, lung Symptoms such as edema and hemoptysis, long-term left atrial pressure increase, accompanied by increased pulmonary pressure and right heart failure, patients with jugular vein filling, anger, lower extremity edema, hepatosplenomegaly, and even ascites sign, tumor thrombus Exfoliation into the systemic circulation can cause cerebral embolism in the brain, kidney, mesentery and lower extremities. In addition, about half of the patients may have symptoms such as hypothermia, mild anemia, weight loss, and poor appetite. These symptoms may be associated with hemorrhage, degeneration and tissue necrosis or body in the tumor. It is related to the allergy of myxoma.
Signs: Most patients have no mitral face and normal blood pressure. Patients with right heart failure can see jugular vein filling and lower extremity edema. In severe cases, they can reach hepatosplenomegaly or have ascites.
Examine
Primary cardiac tumor examination
Cardiac auscultation: rhythm rules, diastolic or systolic or double-phase murmurs can be heard in the apical region. The nature and intensity of heart murmur in some patients can change with body position. This feature is often emphasized by most scholars as a diagnosis of myxomas. According to the apex region, the diastolic murmur is shorter, the noise is more limited, the noise is not widely distributed, and the first sound is hyperthyroidism. In some cases, the tumor can be heard. In the presence of pulmonary hypertension, the pulmonary valve can be heard. To the jet sound, the second sound is hyperactive or split, and the right atrial myxoma can hear diastolic murmurs in the tricuspid region.
(1) Heart sound map
In some patients, the intensity of the noise can vary with different postures.
(2) Electrocardiogram
The electrocardiogram has no characteristic manifestations, which can be a normal electrocardiogram or a manifestation of left atrial right ventricular hypertrophy and myocardial damage. Atrial fibrillation is rare.
(C) cardiac X-ray performance
Similar to the performance of mitral valve disease, the two lungs were stagnation of blood, and the heart was mild to moderately enlarged. The main manifestations were enlargement of the left atrium and right ventricle. The esophageal barium meal examination showed mild to moderate indentation of the esophagus.
(4) Echocardiography
Echocardiography is a non-invasive examination with special diagnostic value for cardiac myxoma.
1 left atrial cavity is enlarged;
2 abnormal echoes of dense cloud-like light clusters appear in the heart chamber;
3 The abnormal echo changes with the opening and closing of the atrioventricular valve. In the diastolic phase, the abnormal echo of the tumor can protrude into the atrioventricular valve or the tumor part protrudes into the left or right ventricle, and the tumor is reintroduced into the atrial cavity during the systolic phase.
(5) Cardiovascular angiography
Intracardiac angiography can provide reference for the location, shape, size and range of motion of cardiac myxoma, but due to the dilution of the contrast agent in the heart chamber and the overlap of the shadows in the heart chamber, the development may be poor, and the left atrium cavity The identification of thrombus still has certain difficulties. In addition, the examination equipment is complicated and costly. Therefore, the diagnosis of cardiac myxoma has been replaced by echocardiography.
Diagnosis
Diagnosis and diagnosis of primary cardiac tumor
diagnosis
Diagnosis can be based on medical history, clinical symptoms, and laboratory tests.
Differential diagnosis
Left atrial myxoma first needs to be differentiated from rheumatic heart disease mitral valve disease. Detailed medical history can provide some basis for differential diagnosis. If the disease has no history of rheumatic fever, it can present a history of transient fainting, and the course of disease is generally short. The disease progresses rapidly, especially in the case of sinus rhythm, and there is no other cause to be investigated. The possibility of left atrial myxoma should be highly suspected. The apical area is short rather than the progressive diastolic murmur, such as the nature of noise. The intensity and intensity change with the change of body position, and can also be used as a reference for differential diagnosis. Echocardiography has special diagnostic value. In order to obtain a clear diagnosis before surgery and avoid unnecessary surgical exploration, rheumatic valvular disease is treated. Preoperative echocardiography is absolutely necessary. Right atrial myxoma needs to be differentiated from tricuspid stenosis, tricuspid valvular, chronic constrictive pericarditis and cardiomyopathy. In some cases, selective cardiac chambers are used. Internal angiography can show the size, location and activity of the tumor for identification.
At the same time, it is necessary to differentially diagnose three tumors of the heart. These three tumors are myxoma, lipoma and rhabdomyosarcoma. The pathological basis of sputum determines the characteristics of ultrasound. Their characteristics can be used as diagnosis and identification. Basis.
1. Myxoma often occurs in the left atrium, but also in the right atrium and right ventricle, but is rarely seen in the left atrium. The myxomas have a clear pedicle attached to the atrial septum or the wall of the chamber, which is thin and short. Myxomas have the risk of falling off, the tumor has a large degree of activity, and it is deformed with the contraction of the heart, and is mostly lobulated.
2, the difference between lipoma and myxoma is mostly in the left or left atrium, and the activity is small and floating, the edge of the tumor is smooth, the echo is strong, and there is no lobulation.
3. Rhabdomyosarcoma occurs in the myocardium of the ventricular wall. There is a clear boundary between the tumor and the normal myocardium, and the arcuate convex shape protrudes into the centripetal cavity.
