Cardiac tumors physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Template:Dj

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.

Vitals

  • Blood pressure
  • Respiratory rate
    • Tachypnea, gasping for breath in case of pulmonary congestion
  • Pulse
  • Pedal Edema



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.

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