Heart metastases

Introduction Cardiac metastasis refers to the transfer of systemic malignancies to the heart by various routes. Here, a tumor is formed and called a cardiac metastasis, which was first reported by Heketoen in 1893. Compared with liver, lung or brain, tumors have less probability of metastasis to the heart, and clinical manifestations are often inconspicuous, but their significance is related to their ability to resemble more common heart diseases and sometimes fatal due to cardiac metastasis.

Cause

Cardiac metastases can occur in all malignant tumors. The most common tumor is lung cancer, and the other common ones are breast cancer melanoma and malignant lymphoma. The most prone to heart metastasis is melanoma. The most common cell type is adenocarcinoma. In recent years, the incidence of AIDS has also played an important role in the lymphatic metastasis of lymphoma and Kaposi sarcoma.

an examination

Related inspection

Dynamic electrocardiogram (Holter monitoring) general radiography examination Doppler echocardiography chest MRI chest CT examination

Clinical manifestations:

The age of onset of cardiac metastases is 2.5 to 58 years old, 77.7% for 21 to 40 years old, and the ratio of male to female is 2.7:1. The disease often has no specific symptoms and signs, and the clinical manifestations vary depending on the type of site of the primary tumor and the location and extent of cardiac metastasis. Common manifestations are: 1. Congestive heart failure: Only tumors appear when the heart is extensively infiltrated, and are intractable and refractory health searches. 2. Arrhythmia: Various types of ectopic beats and tachyarrhythmia can occur in tumor invasion of the myocardium, and atrioventricular or indoor conduction disturbances may occur in the interventricular septum and conduction system, and severe sudden death may occur. 3. Pericardial tamponade: more common in pericardial metastases, also seen in myocardial metastases. 4. Metastasis of the tumor: If it occurs in the atrioventricular valve or ventricular outflow tract, symptoms and signs of obstruction in the corresponding site may occur. In addition, some cases may have stubborn angina, and a few may have myocardial infarction and heart rupture.

Complications: Complications such as congestive heart failure, arrhythmia, pericardial tamponade, myocardial infarction, and heart rupture can occur.

Differential diagnosis

diagnosis:

The disease has a low prenatal diagnosis rate. Patients who have been diagnosed with malignant tumors may consider the possibility of tumor heart metastasis if: 1. Rapidly developing pericardial effusion. 2. Unknown arrhythmia. 3. Sudden heart failure or intractable heart failure. 4. X-ray examination of the heart shows that the heart shadow is huge or limited. 5. There is no coronary heart disease, angina pectoris or acute myocardial infarction, and the effect of vasodilator is not good. 6. Unexplained "myocarditis" suspected tumor heart metastasis can be assisted by techniques such as electrocardiogram, cardiac X-ray, echocardiography, cardiac CT, magnetic resonance, cardiac angiography (ventricular angiography). In addition, pericardial effusion cytology and myocardial biopsy have certain value in the diagnosis of metastatic cardiac tumors.

Cardiac metastases need to be diagnosed as follows:

1. Differentiation from primary cardiac tumors: The incidence of the latter is extremely low, only 1/20 of the former, and the age of onset is small, which is more common in benign cardiac myxoma. Non-cardiac malignant tumor lesions are the main basis for identification.

2. Identification with dilated cardiomyopathy: Both can be characterized as congestive heart failure, and the examination is characterized by enlarged heart and decreased activity. However, cardiac metastases develop rapidly, and the treatment effect on digitalis and diuretics is poor. X-ray films show irregular heart shape, and B-ultrasound, CT and magnetic resonance can find tumor lesions.

3. Identification of pericardial effusion with other causes: the former is mostly bloody, and cancer cells can be found in the effusion, and the treatment effect is poor.

In addition, the arrhythmia and ST-T changes associated with this disease should be distinguished from those caused by other diseases. Cardiac mass and primary tumor are the key to identification.

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