What Is Cardiac Cachexia?

Heart tumors (cardiac tumors), whether benign or malignant, are relatively rare in clinical practice, and primary tumors are more rare. Heart tumors have many symptoms and can easily be confused with other cardiac diseases. Foreign data report that benign tumors account for 3/4 of cardiac tumors, of which nearly half are benign myxomas, and other benign tumors are lipomas, papillary elastic fibroids, and rhabdomyosarcoma; the most common malignant tumors are undifferentiated sarcomas. Angiosarcoma, rhabdomyosarcoma, and lymphoma followed. Heart and pericardial metastases are mostly derived from lung tumors. With the increase of routine physical examination and the development of ultrasound imaging, the detection rate of cardiac tumors has increased year by year.

Basic Information

Visiting department

Cardiac Surgery

Common locations

heart

Common causes

Secondary cardiac tumors are caused by metastatic tumors in other parts of the body

Common symptoms

Chest pain, syncope, congestive heart failure, valvular stenosis or insufficiency, arrhythmia, conduction disorder, intracardiac shunt, constrictive pericarditis, bloody pericardial effusion

Causes of cardiac tumors

Cardiac tumors can be divided into primary and secondary tumors. Primary cardiac tumors are divided into benign and malignant, and secondary cardiac tumors are malignant. They are transferred from malignant tumors in other parts of the body to myocardial tissue, and their incidence is much higher than that of primary cardiac tumors. 30 to 40 times the tumor. Due to the complex types of cardiac tumors, the etiology is unknown. Nearly half of benign cardiac tumors are cardiac mucosal tumors. Other benign cardiac tumors include lipomas, hemangiomas, fibroids, hamartomas, and teratomas. Studies have found that nearly 10% of patients with cardiac myxoma have a family history, and that their chromosomes 2 (Carneg's) and 12 (Kivas-genes) have abnormalities, so patients with cardiac myxoma must ask their family history in detail.

Clinical manifestations of cardiac tumors

The clinical incidence of cardiac tumors is very low, but because the tumors grow in the heart, even benign tumors can cause heart failure due to blockage of the heart cavity, or serious complications such as pulmonary and systemic embolism due to tumor and thromboembolism, and sudden death. . The four most common clinical manifestations are:

1. Heart blood flow obstruction symptoms

The symptoms and signs caused by cardiac tumors can include chest pain, fainting, congestive left heart and / or right heart failure, stenosis or insufficiency of the valve, arrhythmia, conduction disorder, intracardiac shunt, constrictive pericarditis, Bloody pericardial effusion or tamponade.

2. Whole body performance

Cardiac tumors can produce a wide range of noncardiac systemic manifestations, such as fever, anemia, weight loss, accelerated red blood cell sedimentation rate, and cachexia.

3. Arterial embolism

Clinical manifestations of embolism caused by cardiac tumor surface debris or shedding of thrombus, including symptoms of body arterial and / or pulmonary embolism, such as hemiplegia, aphasia, etc.

4. Electrocardiogram abnormalities

Atrial fibrillation, tachycardia, right bundle branch block, atrial or ventricular enlargement, etc.

Cardiac tumor examination

Heart sound map

The murmur intensity of some patients may change with different body positions.

2. ECG

There are no characteristic manifestations, which can be normal ECG or the appearance of left atrial and right ventricular hypertrophy and myocardial damage. Atrial fibrillation is rare.

3. X-ray performance of the heart

It closely resembles the performance of mitral valve disease, with congestion in the two lung fields, and a mild to moderate increase in the heart boundary, mainly manifested by enlargement of the left atrium and right ventricle. Examination of barium meal in the esophagus showed mild to moderate pressure marks.

4. Echocardiography

It is a non-invasive examination and has special diagnostic value for cardiac myxoma. The main manifestations are: the left atrium is enlarged, and abnormal echoes of dense cloud-like light clusters appear in the heart cavity. The abnormal echo changes with the opening and closing of the atrioventricular valve. During the diastole, the abnormal echo of the tumor can protrude into the atrioventricular valve or part of the tumor into the left or right ventricle. In the systole, the tumor reenters the atrial cavity.

5. Cardiovascular angiography

Intracardiac angiography can provide references for the location, shape, size, and range of motion of myxomas in the cardiac cavity, but due to the dilution of the contrast agent in the cardiac cavity and the overlap of the shadows of each cardiac cavity, the development may be poor. In addition, there is still some difficulty in identifying the left atrial cavity thrombus. In addition, the examination equipment is complicated and the cost is large, so the diagnosis of myxoma of the heart cavity has been replaced by echocardiography.

Heart tumor diagnosis

Cardiac tumor diagnosis methods are mainly transthoracic echocardiography, transesophageal echocardiography, computed tomography (CT), and magnetic resonance imaging (MRI). Typical cases of myxoma and some non-myxomatous tumors can be confirmed by echocardiography. Multiple tumors, giant tumors, ventricular tumors, or those with unclear boundaries between the tumor and surrounding tissues should be examined by CT and MRI if necessary.

Differential diagnosis of cardiac tumors

Left atrial myxoma needs to be distinguished from rheumatic heart disease and mitral valve disease. A detailed medical history can provide some basis for differential diagnosis. If the disease has no history of rheumatic fever, a history of transient syncope may be present. The course is generally short and the disease progresses rapidly. Especially in the case of sinus rhythm, systemic embolism occurs and there is no other cause to be investigated. The left atrium should be highly suspected. The possibility of myxoma. Echocardiography has more special diagnostic value. In order to obtain a clear diagnosis before surgery and avoid unnecessary surgical exploration, it is absolutely necessary to perform echocardiography before rheumatic valve disease. Right atrial myxoma needs to be distinguished from tricuspid valve stenosis, tricuspid valve downward movement, chronic constrictive pericarditis, and cardiomyopathy. In some cases, selective intracardiac angiography can show tumor size, location and Activities to identify.

At the same time, three types of tumors, including cardiac myxoma, lipoma, and rhabdomyosarcoma, need to be diagnosed. The pathological basis of these three tumors determines that the ultrasound performance has its own characteristics, and these characteristics can be used as a basis for diagnosis and identification.

Cardiac tumor treatment

Surgical resection is the first choice for the treatment of cardiac tumors, and its prognosis depends on the pathological type and extent of the tumor. As long as benign cardiac tumors can be removed, the prognosis is good, and the recurrence rate of myxoma is low. Surgical treatment of malignant cardiac tumors can clarify the nature of the tumor, relieve mechanical obstruction, and alleviate the symptoms of patients. However, almost all cardiac malignant tumors have a poor prognosis. Surgical treatment is only palliative surgery and is easy to recur. The average survival time is 3 months to 1 year; There are many requirements for heart transplantation and the results are uncertain. For cardiac lymphoma, chemotherapy is the only option.