A Brief Description Of Cardiac Myxomas And The Anesthetic Implications For Anestesia Providers. Some Of The Formatting Of This Paper Has Been Lost....The Superscripts For References Lost Their Format

1973 words - 8 pages

MYXOMA

Cardiac myxomas are rare, benign, slow growing primary cardiac tumors found most commonly in the septum of the left atrium, although they can occur in any chamber of the heart.1,2,3,4 Myxomas account for about 50% of all benign intercardiac tumors making them the most common.14,15,16,17,18 Approximately 70-85% of myxomas occur in the left atrium and the remainder in the right atrium.1,2,5,7,9,10,11,12,13,14,16,17 Very rarely one will occur in either ventricle.1,2,9,12,13,14,16 A very small percentage (10% or less) of myxomas are considered hereditary.1,6,7,9,10,17 Hereditary myxomas typically occur in men in their 20's.1,6 Non-hereditary myxomas most often occur in women between the ages of 30 and 60.6,10,15 Myxomas can appear white, gray, yellow, brown, or green and can range from 1 cm to 15 cm in size13,16 with the average size being 5-6 cm.13 The tumor itself can either be gelatinous with a lobular surface, or more like a firm round mass.7,32 The tumor is quite vascular and may be coated with thrombi.15 About 30-50% of patients experience embolization to the brain, kidneys, eyes, or extremities.4,7,17 The left atrial myxomas often arise from the upper portion of the septum and may prolapse through the mitral valve during diastole.2,7 Although most myxomas are attached to the septum, they may also be attached to the walls of the heart chamber or the valves.14,17 The tumors develop from the endocardium,13 are attached to the wall by a short broad-based attachment called a "stalk", and swing freely within the cardiac chamber.6,12 The freely moving tumor may then intermittently block the mitral valve obstructing blood flow (this mimics mitral stenosis).6,10 When the patients stands up, gravity can also pull the myxoma into the opening of the mitral valve blocking blood flow into the ventricle.6 Mitral regurgitation may occur if the tumor prolapses through the valve and prevents proper valve closure.7 Many of the other symptoms are vague and some patients may not experience ANY symptoms.4 Possible symptoms include:1,2,4,5,6

Approximately 30-50% of patients experience non-specific symptoms including:1,2,4,5,6,7,9,12,13

Low-grade fever, malaise, weight loss, joint pain, Raynaud phenomena

Obstructive cardiac symptoms (Left atrial myxomas mimic mitral stenosis and right atrial myxomas mimic tricuspid stenosis):1,2,4,5,6,7,9,12,13,15

Congestive heart failure

General edema and pulmonary edema

Dizziness, syncope

Cough

Dyspnea with activity and/or lying flat

Clubbing of the fingers

Chest pain

Dysrhythmias, palpitations

Pulmonary hypertension

Lab studies may reveal:1,2,4,5,6,7,9,10,12,13,17,19

Elevated ESR (non-specific marker for inflammation)

Elevated CRP and gamma globulins

Anemia (possibly from mechanical destruction of erythrocytes by the tumor)

Decreased platelets

Elevated WBC

Elevated IL-6

Complications of a myxoma...

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