A “mass on the heart” refers to any abnormal growth or structure found within or on the heart. These masses can vary significantly in their nature, ranging from non-cancerous formations to cancerous tumors, or even non-tumorous growths like blood clots or infectious vegetations. Understanding the specific type of heart mass is important for determining its potential impact on heart function and overall health.
Understanding Different Types of Heart Masses
Heart masses are broadly categorized by their origin. They can be primary, originating directly within the heart, or secondary/metastatic, spreading from another part of the body. Secondary heart masses are significantly more common than primary ones, being 20 to 30 times more frequent.
Primary cardiac masses are further classified as benign (non-cancerous) or malignant (cancerous). About 75% of primary heart tumors are benign. The most common benign primary cardiac tumor in adults is a myxoma, which accounts for 40% to 60% of all primary cardiac tumors. Myxomas are typically found in the left atrium and can range in size, sometimes reaching up to 15 centimeters. These tumors are often attached by a stalk, allowing them to move and potentially interfere with blood flow or break off.
Other benign primary heart tumors include fibromas and rhabdomyomas. Fibromas are composed of connective tissue and are the second most common benign primary heart tumor in children, often found in the ventricles. Rhabdomyomas are the most common heart tumor in infants and children, frequently appearing in clusters within the heart muscle and are often associated with tuberous sclerosis.
Malignant primary cardiac tumors are rare, comprising about 5% to 25% of all primary heart tumors. The most frequent type is angiosarcoma, an aggressive cancer originating from blood vessels. These commonly arise in the right atrium and can spread rapidly.
Non-tumorous masses can also form in the heart. Thrombi (blood clots) develop in heart chambers, especially with irregular rhythms like atrial fibrillation or sluggish blood flow. Vegetations, growths of platelets, fibrin, and microorganisms, typically form on heart valves due to infections like endocarditis, causing inflammation and damage.
Recognizing Potential Symptoms
Symptoms of a heart mass vary widely and often resemble other heart conditions, making diagnosis challenging. Some individuals experience no symptoms. The specific signs and severity depend on the mass’s size, location, mobility, and type.
Symptoms can arise from blood flow obstruction within the heart. A mass blocking blood flow may cause shortness of breath (especially with activity or when lying flat), dizziness, or fainting spells. Chest pain or tightness can also occur due to this obstruction.
Embolization is another potential issue, where a piece of the mass breaks off and travels through the bloodstream. This can lead to serious events like a stroke if the fragment reaches the brain, causing symptoms such as slurred speech, weakness, or vision changes. Emboli can also affect other organs or limbs, leading to pain and damage. Myxomas are known for their potential to embolize, causing various systemic or neurological symptoms.
General systemic effects can also be present, including unexplained fever, unintended weight loss, fatigue, or a general feeling of unwellness. These symptoms are sometimes linked to the body’s inflammatory response to the mass.
Diagnosing a Heart Mass
Diagnosing a heart mass begins with a medical history and physical examination. Since symptoms are often non-specific, imaging techniques are essential to confirm the mass’s presence and characteristics. These methods help determine its size, location, and impact on heart function.
Echocardiography is often the initial and most common imaging tool. This non-invasive ultrasound provides real-time images of heart structures, visualizing the mass, its attachment, mobility, and effects on blood flow or valve function. Transthoracic echocardiography (TTE) is typically performed first. If more detail is needed, transesophageal echocardiography (TEE) offers clearer images by placing a probe down the esophagus.
Cardiac Magnetic Resonance Imaging (MRI) offers detailed heart images with superior tissue contrast, precisely characterizing the mass. MRI differentiates tissue types like fat or fluid, providing information on consistency and blood supply. Cardiac Computed Tomography (CT) scans also provide high-resolution images, useful for visualizing calcifications or relationships to surrounding structures. Both MRI and CT offer a broader field of view than echocardiography.
In some cases, a definitive diagnosis requires a biopsy, which involves taking a small tissue sample for microscopic examination. Biopsy determines the mass’s cellular composition, confirming if it is benign or malignant. This procedure can be performed during surgery or through less invasive catheter-based techniques, guiding treatment decisions.
Treatment Options for Heart Masses
Treatment for a heart mass is individualized, depending on its type, size, location, symptoms, and the patient’s overall health. The goal is to address the mass effectively while minimizing risks to heart function.
Surgical removal is a common approach, especially for benign primary heart tumors like myxomas and fibromas. Complete removal often leads to a cure and prevents complications such as blood flow obstruction or embolization. Surgical techniques range from traditional open-heart surgery to minimally invasive or robotically assisted procedures, which use smaller incisions and offer faster recovery.
For non-tumorous masses, medical management is often the first treatment. Blood clots (thrombi) may be treated with anticoagulant medications to prevent growth and reduce embolization risk. Infectious vegetations from endocarditis require prolonged antibiotics to eradicate the infection. If infection is severe or causes significant valve damage, surgery may be necessary to remove infected tissue or repair/replace the affected heart valve.
Malignant heart masses, especially primary sarcomas like angiosarcoma, are challenging to treat due to their aggressive nature and tendency to spread. Treatment often involves a multi-modal approach, including surgery to remove as much tumor as possible, followed by systemic therapies like chemotherapy or radiation. Complete removal of malignant tumors is not always feasible, and prognosis can be poor, particularly if cancer has spread. Ongoing monitoring and follow-up are important to assess treatment effectiveness and detect recurrence or complications.