Some Notes on Malignancies of the Heart

Abstract

This study was undertaken after an examination made two years ago upon a Mexican male, aged forty-nine, with a to-and-fro murmur. The blood pressure was 90/60 and therefore not characteristic of aortic leak. Ascites existed, but no edema of the extremities. Strangely, no orthopnea was apparent, and the degree of prostration, anemia, and stupor was far greater than is commonly seen in heart disease. In fact, so prominent were the heart symptoms that definite evidence of pulmonary metastases in the x-ray plates were seriously questioned. Impaired resonance and absence of breath sounds prompted us to remove 3550 C.C. of blood-tinged fluid from the right thorax. The ascites masked the presence of any abnormality. CASE REPORTThe patient entered the Los Angeles General Hospital on March 5, 1934, complaining of shortness of breath, gas on the stomach, and weakness. H e stated that he had been in good health up to seven months previously, when he began to suffer from indigestion, manifested by a sense of pressure and a dull, heavy sensation in the abdomen. Shortness of breath was first noticed three months before admission and along with weakness had become progressively worse. Otherwise the history was not significant. There was no cough or expectoration. There was no history of syphilis or rheumatism.On examination, the man did not appear dyspneic; he lay flat in bed without discomfort, but was very weak. The sclerae were not icteric and the pupils reacted to light and accommodation. The blood pressure was 90/60. Examination of the chest showed the heart well over to the left. The rate was regular but rapid, 10@120 beats per minute. A double rough murmur was audible at the third interspace to the left of the sternum. Coarse riles were audible in the left base; the right chest and axilla over the lower two-thirds were flat and without sound, suggesting the presence of fluid and displacement of the heart to the opposite side. No abnormalities were discovered in the abdomen or extremities; no masses were palpated, and there seemed to be no enlargement or tenderness over the liver edge.At first glance this patient seemed to be suffering from a cardiac ailment, but the absence of orthopnea, of dependent edema, and other signs of peripheral circulatory stasis, and the extreme weakness, did not fit the picture. The temperature was normal on admission and at no time did it rise above 99.6" F.On March 12 a roentgenogram of the chest revealed considerable fluid in the right pleural space, and several sharply circumscribed, round areas of slightly increased density were visible throughout both lung fields. These were regarded as suggesting metastatic neoplasm, and the possibility of malignancy involving the heart was considered. A short diastolic murmur was audible over the pulmonary area and a syphilitic regurgitation was suggested, but the Wassermann reaction was negative on two occasions.The body tissues were of good tone and there was no edema.The patient was placed on digitalis and sedatives but without improvement.

Clinical classification of cardiovascular tumors and tumor-like lesions, and its incidences

“…This wide range of incidence may be due to changes of criteria for pathological diagnosis, transition of subjects for autopsy, and changes of diseases for autopsy [9, 10]. Pollia and Gogol [11] reported the highest incidence of tumors originated from the heart as 0.33 % (154 cases) in autopsy of 46,072 cases, while Straus and Merliss [12] reported the lowest incidence as 0.0017 % (8 cases) in autopsy of 480,000 cases by summarizing the autopsy statistics of six hospitals. Reynen [13] reported the incidence as 0.021 % in 731,309 autopsy cases by summarizing the autopsy statistics from the 22 literatures.…”

The hemodynamic destruction of intravascular cancer cells in relation to myocardial metastasis.

“…In the past, metastases to the heart were generally considered to be uncommon, with an overall incidence of 1.5-3% (6)(7)(8). This low incidence may well have reflected the short survival of patients with cancer with consequent limitations of the development of metastases in general and/or be due to, as suggested by Willis (9), inadequate autopsy techniques.…”

Tumor Metastasis to the Heart

“…Another factor mentioned is that the coronary arteries arise from the aorta at right angles. Actually, for types of tumors such as bronchogenic carcinoma, carcinoma of the breast, malignant melanoma, malignant lymphoma, and carcinoma of the pancreas and esophagus, cardiac metastases are relatively common.1', [6][7][8][9][23][24][25][26] Bronchogenic carcinoma frequently involves the heart usually by way of the mediastinal lymphatics. This mode of spread has been stressed by Morris2 …”