Internal Medicine

0521779407-C01 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:53

Cardiac Trauma Cardiac Tumors 281

tests

■ECG – ST changes (very common), new Q waves

■Blood – Elevation of Troponin I and other cardiac enzymes similar

to acute MI

■Echo/Doppler – May show decreased left ventricular function, pend-

ing severity of contusion

■Coronary angiography – may be indicated to define coronary

anatomy

■MRI – define region of injury (severe, large contusions)

differential diagnosis

n/a

management

■Avoid anticoagulation and GPllb/llla inhibitors

■Avoid non-steroidal agents

■Treatment for chest pain (does not respond to nitroglycerin)

■Bed rest (similar to acute MI)

■Monitor and treat for arrhythmias

specific therapy

n/a

follow-up

n/a

complications and prognosis

■Ventricular aneurysm

■Late rupture

Cardiac Tumors.....................................

PRISCILLA HSUE, MD

history & physical

Primary Cardiac Tumors– 75% benign, remainder are malignant

■Benign:

➣Atrial myxoma

most common primary cardiac neoplasm – benign or malig-

nant

peak incidence age 40–60

familial myxoma syndrome – Carney complex

75% in left atrium

treat with prompt surgical removal