A mass on the heart is an abnormal growth of tissue found on the heart structure, its valves, or within the surrounding sac called the pericardium. While the discovery of any growth can be alarming, these masses are not always cancerous. They represent a diverse group of lesions, and understanding their specific nature is the first step in determining the proper course of action. This classification is crucial because it dictates the potential effects on heart function and the ultimate treatment strategy.
Understanding Different Types of Heart Masses
Cardiac masses are broadly classified based on where they originate and whether they are cancerous. A mass is considered primary if it begins within the heart tissue itself, but these are exceedingly rare, occurring in less than 1 in 3,000 individuals. Conversely, secondary, or metastatic, masses are far more common, often appearing 20 to 40 times more frequently than primary tumors. These secondary growths spread to the heart from cancer located elsewhere in the body, such as the lungs, breast, kidney, or from melanoma.
The classification further divides masses into benign (non-cancerous) and malignant (cancerous) types. Approximately 75% of primary cardiac masses are benign. The most common benign primary mass is a Cardiac Myxoma, which typically develops in the left upper chamber, or atrium, of the heart. Myxomas often attach to the wall separating the atria by a stalk, making them mobile and sometimes causing them to interfere with blood flow.
The most frequent type of primary malignant mass is a sarcoma, with Angiosarcoma being the most common. Angiosarcomas are aggressive cancers that arise from the inner lining of blood vessels and are predominantly found in the right atrium. These malignant tumors tend to grow rapidly, infiltrate the heart muscle, and have a high propensity to spread. The fundamental difference between a benign mass like a myxoma and a malignant mass like an angiosarcoma is the latter’s ability to invade and destroy healthy tissue.
Recognizing Common Symptoms
Symptoms of a cardiac mass depend on its exact location, size, and mobility within the heart chambers. Symptoms often mimic those of more common heart conditions, which can make initial diagnosis challenging. One major category of symptoms relates to the mass physically obstructing the normal flow of blood through the heart or its valves. This obstruction can lead to signs of heart failure, such as shortness of breath, fatigue, or swelling in the legs.
A second pattern of symptoms involves the risk of embolism, which occurs when a fragment of the mass breaks off and travels through the bloodstream. If the mass is in the left side of the heart, the fragment can travel to the brain, potentially causing a stroke. A mass in the right side of the heart may send fragments to the lungs, resulting in a pulmonary embolism, which can cause sudden chest pain and difficulty breathing.
The final group of signs are systemic symptoms, which are often non-specific. Patients may experience unexplained fever, night sweats, or unintentional weight loss. These effects can sometimes cause the condition to resemble an infectious disease or an inflammatory disorder. Specialized cardiac imaging is often required for a definitive diagnosis.
How Doctors Diagnose a Cardiac Mass
The diagnostic process for a suspected cardiac mass begins with non-invasive imaging, most commonly a transthoracic echocardiogram (ECHO). This ultrasound of the heart provides real-time images of the heart’s structure and function, allowing doctors to visualize the mass, assess its size, and determine its mobility. The ECHO is highly effective for initially locating the mass and evaluating its immediate impact on blood flow.
Following the initial ECHO, more advanced imaging is often required to better characterize the growth. Cardiac Magnetic Resonance Imaging (MRI) offers superior soft-tissue contrast, which helps in determining the mass’s composition, such as whether it contains fat, fluid, or is solid tissue. MRI can also clearly show the extent to which the mass may be invading the heart muscle or surrounding structures.
A Computed Tomography (CT) scan is useful for detecting calcification within the mass or for visualizing the adjacent structures and lungs. These advanced imaging techniques provide the detailed anatomical and tissue-specific information necessary for surgical planning. The only way to definitively confirm if a mass is benign or malignant is through a biopsy, where a small tissue sample is taken and examined under a microscope. This procedure is essential for guiding the subsequent treatment plan when non-invasive imaging is inconclusive.
Options for Treatment
The management of a cardiac mass depends on its classification: benign, malignant, or secondary. For benign primary masses like a Cardiac Myxoma, surgical removal is the standard and often curative treatment. The mass is carefully excised to prevent complications such as obstruction of blood flow or the risk of embolization. For asymptomatic patients with a low-risk benign mass, a conservative strategy of watchful waiting and regular imaging may be appropriate.
Malignant primary tumors, such as Angiosarcomas, require a more aggressive, multi-modal approach. Treatment typically involves surgical resection to remove as much of the tumor as possible, often followed by systemic therapy like chemotherapy or radiation. If the mass is a secondary metastasis, the treatment strategy is guided by the original cancer’s treatment protocol. In all cases, the goal of treatment is to improve heart function and extend the patient’s survival time.