Atrial myxoma
Encyclopedia
An atrial myxoma is a benign tumor
found in the heart
, commonly in the upper left
or right
side. It grows on the wall (atrial septum) that separates the two sides of the heart.
The tumor is derived from multipotential mesenchymal cells and may cause a ball valve
-type obstruction.
About 75% of myxomas occur in the left atrium of the heart, usually beginning in the wall that divides the two upper chambers of the heart. The rest are in the right atrium. Right atrial myxomas are sometimes associated with tricuspid stenosis and atrial fibrillation
.
Myxomas are more common in women. About 10% of myxomas are passed down through families (inherited). Such tumors are called familial myxomas. They tend to occur in more than one part of the heart at a time, and often cause symptoms at a younger age than other myxomas.
The symptoms and signs of left atrial myxomas often mimic mitral stenosis
.
General symptoms may also be present, such as:
These general symptoms may also mimic those of infective endocarditis
.
. 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.
Tests may include:
Blood tests:
A FBC
may show anemia and increased WBCs (white blood cells). The erythrocyte sedimentation rate
(ESR) is usually increased.
replaced. This can be done during the same surgery.
Myxomas may come back if surgery did not remove all of the tumor cells.
(tumor cells breaking off and traveling with the bloodstream), which can block blood flow. Myxoma fragments can move to the brain
, eye
, or limbs
.
If the tumor grows inside the heart, it can block blood flow through the mitral valve and cause symptoms of mitral stenosis. This may require emergency surgery to prevent sudden death.
Other primary cardiac tumours include:
Tumor
A tumor or tumour is commonly used as a synonym for a neoplasm that appears enlarged in size. Tumor is not synonymous with cancer...
found in the heart
Human heart
The human heart is a muscular organ that provides a continuous blood circulation through the cardiac cycle and is one of the most vital organs in the human body...
, commonly in the upper left
Left atrium
The left atrium is one of the four chambers in the human heart. It receives oxygenated blood from the pulmonary veins, and pumps it into the left ventricle, via the mitral valve.-Foramen ovale:...
or right
Right atrium
The right atrium is one of four chambers in the hearts of mammals and archosaurs...
side. It grows on the wall (atrial septum) that separates the two sides of the heart.
Causes
Myxomas are the most common type of primary heart tumor.The tumor is derived from multipotential mesenchymal cells and may cause a ball valve
Ball valve
A ball valve is a valve with a spherical disc, the part of the valve which controls the flow through it. The sphere has a hole, or port, through the middle so that when the port is in line with both ends of the valve, flow will occur. When the valve is closed, the hole is perpendicular to the ends...
-type obstruction.
About 75% of myxomas occur in the left atrium of the heart, usually beginning in the wall that divides the two upper chambers of the heart. The rest are in the right atrium. Right atrial myxomas are sometimes associated with tricuspid stenosis and atrial fibrillation
Atrial fibrillation
Atrial fibrillation is the most common cardiac arrhythmia . It is a common cause of irregular heart beat, identified clinically by taking a pulse. Chaotic electrical activity in the two upper chambers of the heart result in the muscle fibrillating , instead of achieving coordinated contraction...
.
Myxomas are more common in women. About 10% of myxomas are passed down through families (inherited). Such tumors are called familial myxomas. They tend to occur in more than one part of the heart at a time, and often cause symptoms at a younger age than other myxomas.
Symptoms
Symptoms may occur at any time, but most often they accompany a change of body position. Symptoms may include:- Shortness of breathDyspneaDyspnea , shortness of breath , or air hunger, is the subjective symptom of breathlessness.It is a normal symptom of heavy exertion but becomes pathological if it occurs in unexpected situations...
with activity - Platypnoea - Difficulty breathing in the upright position with relief in the supine position
- Paroxysmal nocturnal dyspnea - Breathing difficulty when asleep
- DizzinessPresyncopePresyncope is a state consisting of lightheadedness, muscular weakness, and feeling faint . Pre-syncope does not result from primary central nervous system pathology, nor does it originate in the inner ear, but is most often cardiovascular in etiology. In many patients, lightheadedness is a symptom...
- FaintingSyncope (medicine)Syncope , the medical term for fainting, is precisely defined as a transient loss of consciousness and postural tone characterized by rapid onset, short duration, and spontaneous recovery due to global cerebral hypoperfusion that most often results from hypotension.Many forms of syncope are...
- PalpitationPalpitationA palpitation is an abnormality of heartbeat that causes a conscious awareness of its beating, whether it is too slow, too fast, irregular, or at its normal frequency. The word may also refer to this sensation itself...
s - Sensation of feeling your heart beat - Chest pain or tightness
- Sudden Death (In which case the disease is an autopsy finding)
The symptoms and signs of left atrial myxomas often mimic mitral stenosis
Mitral stenosis
Mitral stenosis is a valvular heart disease characterized by the narrowing of the orifice of the mitral valve of the heart.-Signs and symptoms:Symptoms of mitral stenosis include:...
.
General symptoms may also be present, such as:
- CoughCoughA cough is a sudden and often repetitively occurring reflex which helps to clear the large breathing passages from secretions, irritants, foreign particles and microbes...
- FeverFeverFever is a common medical sign characterized by an elevation of temperature above the normal range of due to an increase in the body temperature regulatory set-point. This increase in set-point triggers increased muscle tone and shivering.As a person's temperature increases, there is, in...
- CachexiaCachexiaCachexia or wasting syndrome is loss of weight, muscle atrophy, fatigue, weakness, and significant loss of appetite in someone who is not actively trying to lose weight...
- Involuntary weight loss - General discomfort (malaiseMalaiseMalaise is a feeling of general discomfort or uneasiness, of being "out of sorts", often the first indication of an infection or other disease. Malaise is often defined in medicinal research as a "general feeling of being unwell"...
) - Joint painArthralgiaArthralgia literally means joint pain; it is a symptom of injury, infection, illnesses or an allergic reaction to medication....
- Blueness of skin, especially the fingers (Raynaud's phenomenonRaynaud's phenomenonIn medicine, Raynaud's phenomenon is a vasospastic disorder causing discoloration of the fingers, toes, and occasionally other areas. This condition can also cause nails to become brittle with longitudinal ridges. Named for French physician Maurice Raynaud , the phenomenon is believed to be the...
) - Fingers that change color upon pressure or with cold or stress
- Clubbing - Curvature of nails accompanied with soft tissue enlargement of the fingers
- Swelling - any part of the body
These general symptoms may also mimic those of infective endocarditis
Infective endocarditis
Infective endocarditis is a form of endocarditis, or inflammation, of the inner tissue of the heart, such as its valves, caused by infectious agents. The agents are usually bacterial, but other organisms can also be responsible....
.
Diagnosis
The health care provider will listen to the heart with stethoscopeStethoscope
The stethoscope is an acoustic medical device for auscultation, or listening to the internal sounds of an animal body. It is often used to listen to lung and heart sounds. It is also used to listen to intestines and blood flow in arteries and veins...
. 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.
Tests may include:
- Echocardiogram and Doppler studyDoppler echocardiographyDoppler echocardiography is a procedure which uses ultrasound technology to examine the heart. An echocardiogram uses high frequency sound waves to create an image of the heart while the use of Doppler technology allows determination the speed and direction of blood flow by utilizing the Doppler...
- Chest x-rayX-rayX-radiation is a form of electromagnetic radiation. X-rays have a wavelength in the range of 0.01 to 10 nanometers, corresponding to frequencies in the range 30 petahertz to 30 exahertz and energies in the range 120 eV to 120 keV. They are shorter in wavelength than UV rays and longer than gamma...
- CT scan of chest
- Heart MRI
- Left heart angiography
- Right heart angiography
- ECG -- may show atrial fibrillationAtrial fibrillationAtrial fibrillation is the most common cardiac arrhythmia . It is a common cause of irregular heart beat, identified clinically by taking a pulse. Chaotic electrical activity in the two upper chambers of the heart result in the muscle fibrillating , instead of achieving coordinated contraction...
Blood tests:
A FBC
Complete blood count
A complete blood count , also known as full blood count or full blood exam or blood panel, is a test panel requested by a doctor or other medical professional that gives information about the cells in a patient's blood...
may show anemia and increased WBCs (white blood cells). The erythrocyte sedimentation rate
Erythrocyte sedimentation rate
The erythrocyte sedimentation rate , also called a sedimentation rate or Biernacki Reaction, is the rate at which red blood cells sediment in a period of 1 hour...
(ESR) is usually increased.
Treatment
The tumor must be surgically removed. Some patients will also need their mitral valveMitral valve
The mitral valve is a dual-flap valve in the heart that lies between the left atrium and the left ventricle...
replaced. This can be done during the same surgery.
Myxomas may come back if surgery did not remove all of the tumor cells.
Prognosis
Although a myxoma is not cancer, complications are common. Untreated, a myxoma can lead to an embolismEmbolism
In medicine, an embolism is the event of lodging of an embolus into a narrow capillary vessel of an arterial bed which causes a blockage in a distant part of the body.Embolization is...
(tumor cells breaking off and traveling with the bloodstream), which can block blood flow. Myxoma fragments can move to the brain
Human brain
The human brain has the same general structure as the brains of other mammals, but is over three times larger than the brain of a typical mammal with an equivalent body size. Estimates for the number of neurons in the human brain range from 80 to 120 billion...
, eye
Human eye
The human eye is an organ which reacts to light for several purposes. As a conscious sense organ, the eye allows vision. Rod and cone cells in the retina allow conscious light perception and vision including color differentiation and the perception of depth...
, or limbs
Limb (anatomy)
A limb is a jointed, or prehensile , appendage of the human or other animal body....
.
If the tumor grows inside the heart, it can block blood flow through the mitral valve and cause symptoms of mitral stenosis. This may require emergency surgery to prevent sudden death.
Complications
- ArrhythmiasCardiac dysrhythmiaCardiac dysrhythmia is any of a large and heterogeneous group of conditions in which there is abnormal electrical activity in the heart. The heart beat may be too fast or too slow, and may be regular or irregular.Some arrhythmias are life-threatening medical emergencies that can result in cardiac...
- Pulmonary edemaPulmonary edemaPulmonary edema , or oedema , is fluid accumulation in the air spaces and parenchyma of the lungs. It leads to impaired gas exchange and may cause respiratory failure...
- Peripheral emboli
- Spread (metastasisMetastasisMetastasis, or metastatic disease , is the spread of a disease from one organ or part to another non-adjacent organ or part. It was previously thought that only malignant tumor cells and infections have the capacity to metastasize; however, this is being reconsidered due to new research...
) of the tumor - Blockage of the mitral heart valveMitral valveThe mitral valve is a dual-flap valve in the heart that lies between the left atrium and the left ventricle...
- StrokeStrokeA stroke, previously known medically as a cerebrovascular accident , is the rapidly developing loss of brain function due to disturbance in the blood supply to the brain. This can be due to ischemia caused by blockage , or a hemorrhage...
- Fusiform cerebral aneurysms
See also
- MyxomaMyxomaA myxoma is a tumor of primitive connective tissue. It is the most common primary tumor of the heart in adults, but can also occur in other locations....
Other primary cardiac tumours include:
- Papillary fibroelastomaPapillary fibroelastomaA papillary fibroelastoma is a primary tumor of the heart that typically involves one of the valves of the heart. Papillary fibroelastomas, while considered generally rare, make up about 10 percent of all primary tumors of the heart...
- RhabdomyomaRhabdomyomaA rhabdomyoma is a benign tumor of striated muscle. Rhabdomyomas may be either "cardiac" or "extracardiac" . Extracardiac forms of rhabdomyoma are subclassified into three distinct types: Adult type, Fetal type, and Genital type.Cardiac rhabdomyomas are the most common primary tumor of the heart...
s - SarcomaSarcomaA sarcoma is a cancer that arises from transformed cells in one of a number of tissues that develop from embryonic mesoderm. Thus, sarcomas include tumors of bone, cartilage, fat, muscle, vascular, and hematopoietic tissues...
s