Cardiac tumors physical examination: Difference between revisions

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__NOTOC__
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{{Cardiac tumors}}
{{Cardiac tumors}}
{{CMG}}; {{AE}} {{Dj}}
{{CMG}}; {{AE}} {{DMakkar}}


==Overview==
==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.
 
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==
==Physical Examination==
== General Examination==
===General Examination===
*In patients with pulmonary congestion<ref name="pmid24701226">{{cite journal| author=Ostrowski S, Marcinkiewicz A, Kośmider A, Jaszewski R| title=Sarcomas of the heart as a difficult interdisciplinary problem. | journal=Arch Med Sci | year= 2014 | volume= 10 | issue= 1 | pages= 135-48 | pmid=24701226 | doi=10.5114/aoms.2014.40741 | pmc=3953983 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24701226  }} </ref>
*In patients with pulmonary congestion<ref name="pmid24701226">{{cite journal| author=Ostrowski S, Marcinkiewicz A, Kośmider A, Jaszewski R| title=Sarcomas of the heart as a difficult interdisciplinary problem. | journal=Arch Med Sci | year= 2014 | volume= 10 | issue= 1 | pages= 135-48 | pmid=24701226 | doi=10.5114/aoms.2014.40741 | pmc=3953983 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24701226  }} </ref>
**Confusion, agitation, and irritability may be present,  
**Confusion, agitation, and irritability may be present,  
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**Cyanosis of the lips.
**Cyanosis of the lips.


==Vitals==
*Pedal Edema
 
===Vitals===
*Blood pressure
*Blood pressure
**Hypertension mainly. Hypotension in case of [[cardiogenic shock]] due to obstruction.
**Hypertension mainly. Hypotension in case of [[cardiogenic shock]] due to obstruction.
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*Pulse
*Pulse
**[[Tachycardia]]  in shock
**[[Tachycardia]]  in shock
**Regularly Irregular pulse in [[Atrial Fibrillation]]
**Regularly irregular pulse in [[Atrial Fibrillation]]
**Bradycardia in AV Block
**Bradycardia in AV Block
*Pedal Edema


===Neck===
===Neck===
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:*Atrial myxoma,
:*Atrial myxoma,
:*[[Myxoid neurofibroma]], and
:*[[Myxoid neurofibroma]], and
:*[[Ephelides]] (i.e., freckles tanned [[macules]] found on the skin)
:*[[Ephelides]] (i.e., freckles tanned [[macules]] found on the skin)<ref name="pmid29214333">{{cite journal| author=Lee E, Mahani MG, Lu JC, Dorfman AL, Srinivasan A, Agarwal PP| title=Primary cardiac tumors associated with genetic syndromes: a comprehensive review. | journal=Pediatr Radiol | year= 2018 | volume= 48 | issue= 2 | pages= 156-164 | pmid=29214333 | doi=10.1007/s00247-017-4027-2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29214333  }} </ref>


*[[LAMB]] syndrome: It refers to:
*[[LAMB]] syndrome: It refers to:
:*[[Lentigines]],
:*[[Lentigines]],
:*Atrial myxoma, and
:*Atrial myxoma, and
:*Blue nevi
:*Blue nevi<ref name="pmid29214333">{{cite journal| author=Lee E, Mahani MG, Lu JC, Dorfman AL, Srinivasan A, Agarwal PP| title=Primary cardiac tumors associated with genetic syndromes: a comprehensive review. | journal=Pediatr Radiol | year= 2018 | volume= 48 | issue= 2 | pages= 156-164 | pmid=29214333 | doi=10.1007/s00247-017-4027-2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29214333  }} </ref>


==References==
==References==
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[[Category:Up to date]]
[[Category:Disease]]
[[Category:Disease]]
[[Category:Cardiology]]
[[Category:Cardiology]]

Latest revision as of 19:13, 1 December 2022

Cardiac tumors Microchapters

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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

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

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

  • 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:
  • LAMB syndrome: It refers to:

References

  1. 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. 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.

Template:WH Template:WS