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Cardiac Tumors 283
limited success with resection of localized tumors and adju-
vant therapy
➣Mesothelioma
primary; usually diffuse, pericardial tumors
involve both parietal and visceral pericardial layers
extend only superficially into myocardium and rarely involve
cardiac chambers
symptoms are typically pericarditis or tamponade with char-
acteristic hemorrhagic effusion
poor prognosis with surgical excision usually not possible
radiation and chemotherapy result in only temporary im-
provement
Secondary Cardiac Tumors
■20–40×more common than primary cardiac neoplasms
■most common to metastasize to heart are from lung, breast, lym-
phoma, leukemia, renal cell carcinoma, and melanoma (latter has
highest frequency of secondary involvement of the heart)
■mechanisms: direct extension, through lymphatic systems, or by
bloodstream
■signs/symptoms not common – appreciable cardiac dysfunction
occurs in only 10% of patients, the majority from pericardial involve-
ment resulting in constriction and inflammation
■pericardial involvement – pericarditis, pericardial effusion, pericar-
dial constriction
■EKG: nonspecific ST-T abnormalities, low voltage, and atrial arrhyth-
mias
■if effusion, pericardiocentesis to obtain fluid for cytology
Signs & Symptoms
■systemic findings including fever, cachexia, malaise, rash, club-
bing, Raynaud’s phenomenon, arthalgias – similar to presentation
of endocarditis, malignancy or collagen vascular disease
■systemic signs/symptoms resolve when tumor is removed
■peripheral emboli with stroke, myocardial infarction, abdominal
pain, or pulseless extremity
■symptoms caused by anatomic location of tumor if it is located near
valve such as symptoms of valvular stenosis, regurgitation or new
onset heart failure
■infiltrative tumors may cause arrythmias, conduction defects, and
hemodynamic compromise