Cardiac Myxoma: Difference between revisions
Kim Jackson (talk | contribs) No edit summary |
mNo edit summary |
||
| Line 4: | Line 4: | ||
== Introduction == | == Introduction == | ||
The benign tumor known as myxoma develops from [[Connective Tissue|connective tissue.]] Cardiac myxomas are the most common type of myxomas, which are present in the heart. In the left atrium, 75% of myxomas are located, where they originate from a stalk connected to the atrial septum followed by the right atrium with 20% and the ventricles with 8%.The prevalence of atrial myxomas is maximum in the fourth and sixth decade of life and mostly affects females. There are relatively few pediatric patients who have had atrial myxoma. | The benign tumor known as myxoma develops from [[Connective Tissue|connective tissue.]] Cardiac myxomas are the most common type of myxomas, which are present in the heart. In the left atrium, 75% of myxomas are located, where they originate from a stalk connected to the atrial septum followed by the right atrium with 20% and the ventricles with 8%.<ref name=":0">Jain, M. ''et al.'' (2022) ''Early rehabilitation for cerebellar complications following left atrial myxoma excision: A stitch in Time saves Nine'', ''Cureus''. U.S. National Library of Medicine. Available at: <nowiki>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9531849/</nowiki> (Accessed: November 28, 2022).</ref> The prevalence of atrial myxomas is maximum in the fourth and sixth decade of life and mostly affects females. There are relatively few pediatric patients who have had atrial myxoma.<ref name=":1">1. | ||
Nguyen T, Vaidya Y. Atrial Myxoma [Internet]. PubMed. Treasure Island (FL): StatPearls Publishing; 2021. Available from: <nowiki>https://www.ncbi.nlm.nih.gov/books/NBK556040/</nowiki> | |||
</ref> | |||
== Clinical Presentation == | == Clinical Presentation == | ||
The following three symptoms of the common triad are seen in patients: | The following three symptoms of the common triad are seen in patients <ref name=":0" /> | ||
==== | ==== Obstructive Symptoms ==== | ||
If the patient has a left-sided myxoma, the mitral valve will get blocked, resulting in left-sided heart failure, which will lead to orthopnea, paroxysmal nocturnal dyspnea, and pulmonary edema. Consequently, tricuspid stenosis and right heart failure develop in the right-sided myxoma. Typical symptoms include ascites, hepatomegaly, pedal edema, and exercise-induced dyspnea. | If the patient has a left-sided myxoma, the mitral valve will get blocked, resulting in left-sided heart failure, which will lead to orthopnea, paroxysmal nocturnal dyspnea, and pulmonary edema. Consequently, tricuspid stenosis and right heart failure develop in the right-sided myxoma. Typical symptoms include ascites, hepatomegaly, pedal edema, and exercise-induced dyspnea.<ref name=":1" /> | ||
==== ''' | ==== '''Thromboembolic Symptoms''' ==== | ||
Left atrial myxomas were strongly related | Left atrial myxomas were strongly related to an elevated risk of systemic embolization because of the location and the high systolic pressure. As a result, patients may present with a range of symptoms, including transient ischemia attack, hemiplegia, visual loss, chest discomfort, dyspnea, and neurological abnormalities. If an atrial septal defect or a patent foramen ovale also exists, right atrial myxomas can cause a pulmonary arterial embolism or systemic embolism. Hypoxia, tachycardia, or abrupt death are all symptoms of pulmonary embolism. The symptoms of systemic embolization are similar to those of left atrial myxoma.<ref name=":1" /> | ||
==== | ==== Constitutional Symptoms ==== | ||
Fever, lethargy, anorexia, arthralgia, and weight loss are among the constitutional symptoms of atrial myxoma. These symptoms are strongly correlated with the release of the cytokine IL-6, which is essential for the proliferation of myxoma cells and the production of acute-phase reactants.<ref name=": | Fever, lethargy, anorexia, arthralgia, and weight loss are among the constitutional symptoms of atrial myxoma. These symptoms are strongly correlated with the release of the cytokine IL-6, which is essential for the proliferation of myxoma cells and the production of acute-phase reactants.<ref name=":2">Islam AKMM. Cardiac myxomas: A narrative review [Internet]. World journal of cardiology. U.S. National Library of Medicine; 2022 [cited 2022Nov28]. Available from: <nowiki>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9048271/</nowiki></ref> | ||
== Investigations == | == Investigations == | ||
The essential test for diagnosing cardiac myxomas is Echocardiography. Computed tomography (CT) scanning and Magnetic resonance imaging (MRI) are advanced imaging modalities that are used in conjunction with one another.<ref name=":2" /> Routine hematological tests reveal [[anaemia]], leukocytosis, thrombocytopenia, a high erythrocyte sedimentation rate, and increased gamma globulin. <ref name=":2" />The diagnosis is confirmed by histopathology. In myxoma cases that run in families, genetic testing is necessary.<ref name=":1" /> | |||
The essential test for diagnosing cardiac myxomas is Echocardiography. Computed tomography (CT) scanning and Magnetic resonance imaging (MRI) are advanced imaging modalities that are used in conjunction with one another.<ref name=":2" | |||
== Differential Diagnosis == | == Differential Diagnosis == | ||
Sometimes cardiac myxoma | Sometimes cardiac myxoma is incorrectly diagnosed.<ref name=":3">1. | ||
Aiello VD, Campos FPF de. Cardiac Myxoma. Autopsy and Case Reports [Internet]. 2016;6(2):5–7. Available from: <nowiki>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4982778/</nowiki> | Aiello VD, Campos FPF de. Cardiac Myxoma. Autopsy and Case Reports [Internet]. 2016;6(2):5–7. Available from: <nowiki>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4982778/</nowiki> | ||
</ref> They have | </ref> They have several important differential diagnoses, including mural thrombi with myxoid stroma<ref name=":1" /> intracardiac thrombus and other cardiac malignancy.<ref name=":3" /> Immunohistochemistry testing is useless since the histopathological appearance of the two diseases is same. To distinguish them from mural myxoid thrombi, the myxoma-specific marker calretinin might be used.<ref name=":1" /> | ||
== Management == | == Management == | ||
Surgical removal of cardiac myxomas is frequently necessary | Surgical removal of cardiac myxomas is frequently necessary for an emergency. This lowers the possibility of embolization of the tumor. The surgery itself is uncomplicated. The interatrial septum next to the heart is completely removed, along with the stalk's root, and the resulting aThe main problem the patient faced after excision of tumor is swelling in the lower limbs, decreased lung airflow, an accumulation of secretions, diffictrial septal defect is then repaired.<ref name=":2" /> Placing a pericardial patch can aid in correcting flaws that primary closure is unable to correct. To rule out the presence of metastases or further malignant tumors, the excised tumor is sent to pathology. Recurrent atrial myxoma may be treated with cardiac autotransplantation.<ref name=":1" /><br> | ||
== Physiotherapy Management == | == Physiotherapy Management == | ||
The main problem the patient faced after excision of tumor is swelling in the lower limbs, decreased lung airflow, an accumulation of secretions, difficulty getting in and out of bed, impaired proprioception and coordination, diminished strength, unstable sitting, and difficulty walking. The ability to perform activities of daily living is the primary goal of the patient's early rehabilitation.<ref name=":0" /> | The main problem the patient faced after the excision of the tumor is swelling in the lower limbs, decreased lung airflow, an accumulation of secretions, difficulty getting in and out of bed, impaired proprioception and coordination, diminished strength, unstable sitting, and difficulty walking. The ability to perform activities of daily living is the primary goal of the patient's early rehabilitation.<ref name=":0" /> | ||
=== Goals Of Rehabilitation === | === Goals Of Rehabilitation === | ||
| Line 41: | Line 44: | ||
* To avoid postural imbalance | * To avoid postural imbalance | ||
* Enhance bed mobility and protect skin from pressure sores | * Enhance bed mobility and protect skin from pressure sores | ||
* Enhance functional efficiency, proprioception and coordination | * Enhance functional efficiency, proprioception, and coordination | ||
* Improve sitting balance and strength | * Improve sitting balance and strength | ||
* [[Gait|Gait training]]<ref name=":0" /> | * [[Gait|Gait training]]<ref name=":0" /> | ||
| Line 56: | Line 59: | ||
* Proprioceptive neuromuscular facilitation (PNF) | * Proprioceptive neuromuscular facilitation (PNF) | ||
* [[Strength Training in Neurological Rehabilitation|Strength Training]] | * [[Strength Training in Neurological Rehabilitation|Strength Training]] | ||
* Seated marching, knee extension, toe taps, knee to chest, single leg stance, side leg raises, ankle dorsiflexion, toe raises, and heel raises. | * Seated marching, knee extension, toe taps, knee to chest, single leg stance, side leg raises, ankle dorsiflexion, toe raises, and heel raises. <ref name=":0" /> | ||
Early diagnosis, treatment, and most importantly, rehabilitation, all play significant roles in returning the patient to functional state. Regular exercise will benefit the patient and minimizes postoperative complications.<ref name=":0" /> | Early diagnosis, treatment, and most importantly, rehabilitation, all play significant roles in returning the patient to functional state. Regular exercise will benefit the patient and minimizes postoperative complications.<ref name=":0" /> | ||
| Line 65: | Line 68: | ||
== References == | == References == | ||
# Jain M | # Jain, M. ''et al.'' (2022) ''Early rehabilitation for cerebellar complications following left atrial myxoma excision: A stitch in Time saves Nine'', ''Cureus''. U.S. National Library of Medicine. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9531849/ (Accessed: November 28, 2022). | ||
# Nguyen T, Vaidya Y. Atrial Myxoma [Internet]. PubMed. Treasure Island (FL): StatPearls Publishing; 2021. Available from: https://www.ncbi.nlm.nih.gov/books/NBK556040/ | # Nguyen T, Vaidya Y. Atrial Myxoma [Internet]. PubMed. Treasure Island (FL): StatPearls Publishing; 2021. Available from: https://www.ncbi.nlm.nih.gov/books/NBK556040/ | ||
# | # Islam AKMM. Cardiac myxomas: A narrative review [Internet]. World journal of cardiology. U.S. National Library of Medicine; 2022 [cited 2022Nov28]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9048271/ | ||
# Aiello VD, Campos FPF de. Cardiac Myxoma. Autopsy and Case Reports [Internet]. 2016;6(2):5–7. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4982778/ | # Aiello VD, Campos FPF de. Cardiac Myxoma. Autopsy and Case Reports [Internet]. 2016;6(2):5–7. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4982778/<nowiki/> | ||
| |||
Revision as of 20:58, 28 November 2022
Introduction[edit | edit source]
The benign tumor known as myxoma develops from connective tissue. Cardiac myxomas are the most common type of myxomas, which are present in the heart. In the left atrium, 75% of myxomas are located, where they originate from a stalk connected to the atrial septum followed by the right atrium with 20% and the ventricles with 8%.[1] The prevalence of atrial myxomas is maximum in the fourth and sixth decade of life and mostly affects females. There are relatively few pediatric patients who have had atrial myxoma.[2]
Clinical Presentation[edit | edit source]
The following three symptoms of the common triad are seen in patients [1]
Obstructive Symptoms[edit | edit source]
If the patient has a left-sided myxoma, the mitral valve will get blocked, resulting in left-sided heart failure, which will lead to orthopnea, paroxysmal nocturnal dyspnea, and pulmonary edema. Consequently, tricuspid stenosis and right heart failure develop in the right-sided myxoma. Typical symptoms include ascites, hepatomegaly, pedal edema, and exercise-induced dyspnea.[2]
Thromboembolic Symptoms[edit | edit source]
Left atrial myxomas were strongly related to an elevated risk of systemic embolization because of the location and the high systolic pressure. As a result, patients may present with a range of symptoms, including transient ischemia attack, hemiplegia, visual loss, chest discomfort, dyspnea, and neurological abnormalities. If an atrial septal defect or a patent foramen ovale also exists, right atrial myxomas can cause a pulmonary arterial embolism or systemic embolism. Hypoxia, tachycardia, or abrupt death are all symptoms of pulmonary embolism. The symptoms of systemic embolization are similar to those of left atrial myxoma.[2]
Constitutional Symptoms[edit | edit source]
Fever, lethargy, anorexia, arthralgia, and weight loss are among the constitutional symptoms of atrial myxoma. These symptoms are strongly correlated with the release of the cytokine IL-6, which is essential for the proliferation of myxoma cells and the production of acute-phase reactants.[3]
Investigations[edit | edit source]
The essential test for diagnosing cardiac myxomas is Echocardiography. Computed tomography (CT) scanning and Magnetic resonance imaging (MRI) are advanced imaging modalities that are used in conjunction with one another.[3] Routine hematological tests reveal anaemia, leukocytosis, thrombocytopenia, a high erythrocyte sedimentation rate, and increased gamma globulin. [3]The diagnosis is confirmed by histopathology. In myxoma cases that run in families, genetic testing is necessary.[2]
Differential Diagnosis[edit | edit source]
Sometimes cardiac myxoma is incorrectly diagnosed.[4] They have several important differential diagnoses, including mural thrombi with myxoid stroma[2] intracardiac thrombus and other cardiac malignancy.[4] Immunohistochemistry testing is useless since the histopathological appearance of the two diseases is same. To distinguish them from mural myxoid thrombi, the myxoma-specific marker calretinin might be used.[2]
Management[edit | edit source]
Surgical removal of cardiac myxomas is frequently necessary for an emergency. This lowers the possibility of embolization of the tumor. The surgery itself is uncomplicated. The interatrial septum next to the heart is completely removed, along with the stalk's root, and the resulting aThe main problem the patient faced after excision of tumor is swelling in the lower limbs, decreased lung airflow, an accumulation of secretions, diffictrial septal defect is then repaired.[3] Placing a pericardial patch can aid in correcting flaws that primary closure is unable to correct. To rule out the presence of metastases or further malignant tumors, the excised tumor is sent to pathology. Recurrent atrial myxoma may be treated with cardiac autotransplantation.[2]
Physiotherapy Management[edit | edit source]
The main problem the patient faced after the excision of the tumor is swelling in the lower limbs, decreased lung airflow, an accumulation of secretions, difficulty getting in and out of bed, impaired proprioception and coordination, diminished strength, unstable sitting, and difficulty walking. The ability to perform activities of daily living is the primary goal of the patient's early rehabilitation.[1]
Goals Of Rehabilitation[edit | edit source]
- To avoid deep vein thrombosis
- To enhance lung aeration
- To avoid postural imbalance
- Enhance bed mobility and protect skin from pressure sores
- Enhance functional efficiency, proprioception, and coordination
- Improve sitting balance and strength
- Gait training[1]
Intervention[edit | edit source]
- Limb elevation, ankle foot toe movement, along with calf strengthening
- Diaphragmatic breathing, thoracic expansion exercises, and regular Incentive Spirometry
- Nebulization, chest physiotherapy followed by suctioning
- Chest binders and positioning every two hours
- Rolling Facilitation and Training for transitions from lying down to sitting and standing up.
- Proprioceptive training and joint compression
- Coordination exercises include finger to nose, finger to therapist's finger, alternate nose to finger, finger opposition, pronation/supination, heel to shin, and Frankel exercises
- Proprioceptive neuromuscular facilitation (PNF)
- Strength Training
- Seated marching, knee extension, toe taps, knee to chest, single leg stance, side leg raises, ankle dorsiflexion, toe raises, and heel raises. [1]
Early diagnosis, treatment, and most importantly, rehabilitation, all play significant roles in returning the patient to functional state. Regular exercise will benefit the patient and minimizes postoperative complications.[1]
Case Reports[edit | edit source]
Abdulmajid L, Addouli HE, Paelinck B, Bock DD. Natural Growth of Left Atrial Myxoma. The Annals of Thoracic Surgery [Internet]. 2021 Apr 1 [cited 2022 Nov 27];111(4):e275–7. Available from: https://www.annalsthoracicsurgery.org/article/S0003-4975(20)31439-9/fulltext
References[edit | edit source]
- Jain, M. et al. (2022) Early rehabilitation for cerebellar complications following left atrial myxoma excision: A stitch in Time saves Nine, Cureus. U.S. National Library of Medicine. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9531849/+(Accessed:+November+28,+2022).
- Nguyen T, Vaidya Y. Atrial Myxoma [Internet]. PubMed. Treasure Island (FL): StatPearls Publishing; 2021. Available from: https://www.ncbi.nlm.nih.gov/books/NBK556040/
- Islam AKMM. Cardiac myxomas: A narrative review [Internet]. World journal of cardiology. U.S. National Library of Medicine; 2022 [cited 2022Nov28]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9048271/
- Aiello VD, Campos FPF de. Cardiac Myxoma. Autopsy and Case Reports [Internet]. 2016;6(2):5–7. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4982778/
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 Jain, M. et al. (2022) Early rehabilitation for cerebellar complications following left atrial myxoma excision: A stitch in Time saves Nine, Cureus. U.S. National Library of Medicine. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9531849/ (Accessed: November 28, 2022).
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 1. Nguyen T, Vaidya Y. Atrial Myxoma [Internet]. PubMed. Treasure Island (FL): StatPearls Publishing; 2021. Available from: https://www.ncbi.nlm.nih.gov/books/NBK556040/
- ↑ 3.0 3.1 3.2 3.3 Islam AKMM. Cardiac myxomas: A narrative review [Internet]. World journal of cardiology. U.S. National Library of Medicine; 2022 [cited 2022Nov28]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9048271/
- ↑ 4.0 4.1 1. Aiello VD, Campos FPF de. Cardiac Myxoma. Autopsy and Case Reports [Internet]. 2016;6(2):5–7. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4982778/
