What is cardiac sarcoma?
Cardiac sarcoma is a type of tumor that occurs in the heart. Cardiac sarcoma is a primary malignant (cancerous) tumor. Tumors are considered to be either primary tumors or secondary tumors. A primary tumor is the original site of tumor growth. A secondary tumor originates from another tumor elsewhere in the body. Primary tumors of the heart are rare, and most are benign (non-cancerous).
What are the symptoms of cardiac sarcoma?
The symptoms of heart tumors will vary, depending on the location of the tumor. Tumors of the heart may occur on the outside surface of the heart, within one or more chambers of the heart (intracavitary), or within the muscle tissue of the heart.
Cardiac sarcomas, most frequently, are a type of sarcoma called angiosarcomas. Angiosarcomas usually begin in the right atrium (right upper chamber) of the heart, or on the pericardium (outer surface) of the heart. Most angiosarcomas occur in the right atrium resulting in obstruction of the inflow or outflow of blood. This obstruction may cause symptoms such as swelling of the feet, legs, ankles, and/or abdomen, and distension of the neck veins, because the blood coming back to the heart after traveling through the body cannot easily enter or be pumped out of the right atrium.
Cardiac angiosarcomas that occur on the pericardium can cause increased fluid in the pericardial sac, the thin covering that surrounds the heart. If enough fluid accumulates within the pericardial sac, the heart's ability to pump blood is affected. Some signs of this occurrence may include chest pain, shortness of breath, fatigue, and palpitations.
Tiny pieces (emboli) of cardiac sarcomas may break off and travel through the bloodstream to other parts of the body. An embolus may block blood flow to an organ or body part, causing pain and damage to the organ or body part that lies beyond the point at which the blood flow is obstructed.
Emboli can affect the brain (causing a stroke), the lungs (causing respiratory distress), and/or other organs and body parts.
Additional symptoms include hemoptysis (coughing up blood), heart rhythm problems, and upper facial congestion. Other signs of cardiac sarcoma not related to the location of the tumor in the heart may include fever, weight loss, night sweats, and malaise (fatigue, tiredness, or "not feeling well").
The symptoms of cardiac sarcoma may resemble other cardiac or medical conditions. Always consult your physician for a diagnosis.
How is cardiac sarcoma diagnosed?
The methods for diagnosing cardiac sarcoma vary, to some degree, based on the symptoms present. In addition to a complete medical history and physical examination, diagnostic procedures for cardiac sarcoma may include the following:
Echocardiogram (also known as echo) - A noninvasive test that uses sound waves to produce a study of the motion of the heart's chambers and valves. The echo sound waves create an image on the monitor as an ultrasound transducer is passed over the skin over the heart. Echocardiography has become the most useful tool in the diagnosis of cardiac sarcoma, allowing the physician to see the exact size and location of the tumor.
Electrocardiogram (ECG or EKG) - A test that records the electrical activity of the heart, shows abnormal rhythms (arrhythmias or disrhythmias), and detects heart muscle damage; cardiac sarcoma may cause changes in the heart's rhythm, however, these EKG changes may indicate other heart problems, so other diagnostic tools are needed to make a definitive diagnosis of cardiac sarcoma or any other type of heart tumor.
Computed tomography (Also called a CT or CAT scan.) - - A diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays and are used to further define the tumor's size, location, and other characteristics.
Magnetic resonance imaging (MRI) - A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body; to further define the tumor's size, location, and other characteristics.
Chest x-ray - A diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film; may detect heart enlargement or pulmonary congestion.
Cardiac catheterization - With this procedure, x-rays are taken after a contrast agent (dye) is injected into an artery to locate the narrowing, occlusions, and other abnormalities of specific arteries.
Biopsy - This is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that the tumor is cancerous, but the only way to know for sure is by doing a biopsy. The piece of tumor removed is analyzed by a pathologist (a doctor who specializes in evaluating cells, tissues, and organs to diagnose disease).
Treatment for cardiac sarcoma:
Specific treatment for cardiac sarcoma will be determined by the physician based on:
- Your age, overall health, and medical history
- Extent of the disease
- Your tolerance for specific medications, procedures, or therapies
- Expectations for the course of the disease
- Your opinion or preference
Once a cardiac sarcoma has progressed to the point that symptoms begin to occur, it has often spread to other parts of the body, making treatment difficult and challenging. This spread to other parts of the body is called metastasis. The type of treatment for cardiac sarcoma depends largely upon the location and size of the tumor, as well as the extent of metastasis.
The physician may determine that the tumor can be removed, which is done with an open-heart surgical procedure. This is often difficult, however, because of the location of the tumor.
In some cases, the sarcoma has invaded the heart to such an extent that it is impossible to remove it completely. In this situation, heart transplantation has been attempted. However, a patient must receive immunosuppressive medication (medications which help to prevent the body from rejecting foreign tissue) after transplant, and this medication may stimulate new growth of sarcoma.
An exciting new prospect for treatment of cardiac sarcoma is auto transplantation. Auto transplantation is a surgical procedure in which the patient's own heart is removed so that the tumor can be more completely and easily removed from the heart tissue. After the tumor is removed, the heart is replaced into the patient. Because the patient has not received a heart from another person, there is no need for immunosuppressive medications. New drug treatments are also being studied, and may be available in clinical trials.
In some cases, radiation therapy or chemotherapy may be given to help relieve symptoms or improve a person's quality of life.
Atrial Fibrillation is also known to occur in patients without any other indication of a heart disease. This is more frequent in younger people and this condition is referred to as lone atrial fibrillation. Various other causes for Atrial fibrillation include hyperthyroidism or overactive thyroid, alcohol use, pulmonary embolism which refers to a blockage in the main artery of the lung, pneumonia, left ventricular hypertrophy or an enlargement of the ventricular walls, coronary heart disease, high blood pressure, myocardial infarction, age etc.
What are the symptoms of Atrial Fibrillation?
The symptoms associated with Atrial Fibrillation are as follows:
- Palpitations or rapid, irregular heart beats.
- Shortness of breath
- Chest pain
Atrial Fibrillation affects both men and women. The risk increases with age and according to the statistics, one in four individuals who are aged 40 years or older, will develop Atrial Fibrillation during their lifetime. It is common in people who have diseases such as coronary heart disease, rheumatic heart disease, pericarditis etc. People who are obese or have high blood pressure also have a high risk factor. Atrial Fibrillation can be potentially lethal if left untreated as it leads to consequences like stroke which may further lead to permanent brain damage. The risk of stroke increases with age and if proper anticoagulation therapy is not initiated by means of blood thinners like warfarin, stroke may affect 1.3 percent of people suffering from AF who are 50-59 years old.
How is Atrial Fibrillation Diagnosed?
In some cases patients having Atrial Fibrillation do not experience any direct symptoms suggestive of it. Therefore the condition is diagnosed following a physical examination or an electrocardiogram test in most cases. The doctors may also check the patients medical history and family histories.include:
How is atrial fibrillation treated?
The goals of treatment for atrial fibrillation include regaining a normal heart rhythm (sinus rhythm), controlling the heart rate, preventing blood clots and reducing the risk of stroke.
Many options are available to treat atrial fibrillation, including lifestyle changes, medications, catheter-based procedures and surgery. The type of treatment that is recommended for you is based on your heart rhythm and symptoms.
Initially, medications are used to treat atrial fibrillation. Medications may include:
Rhythm control medications (anti arrhythmic drugs)
Antiarrhythmic medications help return the heart to its normal sinus rhythm or maintain normal sinus rhythm.
There are several types of rhythm control medications, including: procainamide (Pronestyl); disopyramide (Norpace); flecainide acetate (Tambocor); propafenone (Rythmol); sotalol (Betapace); dofetilide (Tikosyn) and amiodarone (Cordarone).
You may have to stay in the hospital when you first start taking these medications so your heart rhythm and response to the medication can be carefully monitored. These medications are effective 30 to 60 percent of the time, but may lose their effectiveness over time. Your doctor may need to prescribe several different anti arrhythmic medications to determine the right one for you.
Some rhythm control medications may actually cause more arrhythmias, so it is important to talk to your doctor about your symptoms and any changes in your condition.
Rate control medications
Rate control medications, such as digoxin (Lanoxin), beta-blockers [metoprolol (Toprol, Lopressor)], and calcium channel blockers such as verapamil (Calan) or diltiazem (Cardizem), are used to help slow the heart rate during atrial fibrillation. These medications do not control the heart rhythm, but do prevent the ventricles from beating too rapidly.
Anticoagulant or antiplatelet therapy medications, such as warfarin (Coumadin) or aspirin, reduce the risk of blood clots and stroke, but they do not eliminate the risk. Regular blood tests are required when taking Coumadin to evaluate the effectiveness of the drug. Talk to your doctor about the anticoagulant medication that is right for you.
In addition to taking medications, there are some changes you can make to improve your heart health.
- If your irregular heart rhythm occurs more often with certain activities, tell your doctor. Sometimes, your medications may need to be adjusted.
- Quit smoking.
- Limit your intake of alcohol. Moderation is the key. Ask your doctor for specific alcohol guidelines.
- Limit the use of caffeine. Some people are sensitive to caffeine and may notice more symptoms when using caffeinated products (such as tea, coffee, colas and some over-the- counter medications).
- Beware of stimulants used in cough and cold medications, as some of these medications contain ingredients that may increase the risk of irregular heart rhythms. Read medication labels and ask your doctor or pharmacist what type of cold medication is best for you.
When medications do not work to correct or control atrial fibrillation, or when medications are not tolerated, a procedure may be necessary to treat the abnormal heart rhythm, such as: electrical cardio version, pulmonary vein antrum isolation procedure, ablation of the AV node followed by pacemaker placement, or surgical ablation (Maze procedure or minimally invasive surgical treatment).
Electrical cardio version:A cardio version electrically "resets" the heart. Medications alone are not always effective in converting atrial fibrillation to a more normal rhythm. Sometimes cardio version is used to restore a normal heart rhythm and allow the medication to successfully maintain the normal rhythm. Cardio version frequently restores a normal rhythm, although its effect may not be permanent. After a short-acting anesthesia is given that puts the patient to sleep, an electrical shock is delivered through patches placed on the chest wall. This shock will synchronize the heartbeat and restore a normal rhythm.
Catheter ablation:Catheter ablation may be an option for people who cannot tolerate medications or when medications are not effective in maintaining a normal heart rhythm. Pulmonary vein ablation and ablation of the AV node are the two types of catheter ablation procedures used to treat atrial fibrillation. Both are performed by an electro physiologist (doctor who specializes in treating heart rhythm conditions).
Because atrial fibrillation usually begins in the pulmonary veins or at their attachment to the left atrium, energy is applied around the connections of the pulmonary veins to the left atrium during the pulmonary vein ablation procedure (also called pulmonary vein antrum isolation or PVAI).
First, the doctor inserts catheters (long, flexible tubes) into the blood vessels of the leg, and sometimes the neck, and guides the catheters into the atrium. Energy is delivered through the tip of the catheter to the tissue targeted for ablation. Frequently, other areas involved in triggering or maintaining atrial fibrillation are also targeted.
Small circular scars eventually form and prevent the abnormal signals that cause atrial fibrillation from reaching the rest of the atrium. However, the scars created during this procedure may take from 2 to 3 months to form. Once the scars form, they block any impulses firing from within the pulmonary veins, thereby electrically "disconnecting" them or "isolating" them from the heart. This allows the SA node to once again direct the heart rhythm and a normal sinus rhythm is restored.
Because it takes several weeks for the lesions to heal and form scars, it is common to experience atrial fibrillation early during the recovery period. Rarely, atrial fibrillation may be worse for a few weeks after the procedure and may be related to inflammation where the lesions were created. In most patients, these episodes subside within 1 to 3 months.
Ablation of the AV node:During this type of ablation, catheters are inserted through the veins (usually in the groin) and guided to the heart. Radiofrequency energy is delivered through the catheter to sever or injure the AV node. This prevents the electrical signals of the atrium from reaching the ventricle. This result is permanent, and therefore, the patient needs a permanent pacemaker to maintain an adequate heart rate. Although this procedure can reduce atrial fibrillation symptoms, it does not cure the condition. Because the patient will continue to have atrial fibrillation, an anticoagulant medication is prescribed to reduce the risk of stroke.
Important note: Due to better treatment alternatives, AV node ablation is rarely used to treat atrial fibrillation.
Permanent Pacemaker: A pacemaker is a device that sends small electrical impulses to the heart muscle to maintain a suitable heart rate. Pacemakers are implanted in people with AF who have a slow heart rate. The pacemaker has a pulse generator (that houses the battery and a tiny computer) and leads (wires) that send impulses from the pulse generator to the heart muscle, as well as sense the heart's electrical activity.
Newer pacemakers have many sophisticated features, designed to help with the management of arrhythmias and to optimize heart rate-related function as much as possible.
Certain patients are candidates for surgical treatment of atrial fibrillation. These include patients with one or more of the following characteristics:
During the Maze procedure, a series of precise incisions or lesions are made in the right and left atria to confine the electrical impulses to defined pathways to reach the AV node. These incisions prevent the abnormal impulses from affecting the atria and causing atrial fibrillation.
The surgical Maze procedure can be performed traditionally with a technique in which precise surgical scars are created in the atria. It may also be performed using newer technologies designed to create lines of conduction block with radiofrequency, microwave, laser, ultrasound or cryothermy (freezing). With these techniques, lesions and ultimately scar tissue is created to block the abnormal electrical impulses from being conducted through the heart and to promote the normal conduction of impulses through the proper pathway.
Many of these approaches can be performed with minimally invasive (endoscopic or "keyhole") surgical techniques.
Your doctor will talk with you about the procedure that is best for you based on your medical condition.
If a patient has atrial fibrillation and requires surgery to treat other heart problems (such as valve disease or coronary artery disease), the surgeon may perform the surgical treatment for atrial fibrillation at the same time. Virtually all surgical approaches include excision or exclusion of the atrial appendage. The left atrial appendage is a small, ear-shaped tissue flap located in the left atrium. This tissue is a potential source of blood clots in patients who have atrial fibrillation. During surgical procedures to treat atrial fibrillation, the left atrial appendage is removed and the tissue is closed with a special stapling device.