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Dr. Mete ALPASLAN
Cardiac Tumors and the ECG
Primary cardiac tumors are very rare.
Most cardiac tumors are secondary metastases from extracardiac sites.
ECG findings vary according to tumor localization.
Atrial tumors may show
- atrial arrhythmias (atrial fibrillation , atrial flutter, etc.)
- P wave or PR segment abnormalities
Tumors involving the AV node or
interventricular septum may show
- AV block
- bundle branch block
Tumors involving the ventricles may show
- ventricular arrhythmias (ventricular tachycardia, idioventricular rhythm, VPC, ventricular fibrillation)
- sudden cardiac death
- ST segment or T wave changes suggesting acute or old myocardial infarction
- non-specific ST segment or T wave changes
- ST segment elevation in right precordial leads (may mimick Brugada pattern)
- low voltage (due to destruction of the myocardium or pericardial effusion)
ECG findings and arrhythmias in frequently observed types of some cardiac tumors
Rhabdomyomas
The most frequent type of primary cardiac tumor.
Tuberous Sclerosis accompanies in most patients.
Arrhythmias are observed in 13% of the patients.
Ventricular tachycardia attacks are observed in 16%. As the tumor regresses in time, ventricular arrhythmias may also disappear.
Asymptomatic pre-excitation (WPW syndrome) may be seen. As the tumor regresses in time, pre-excitation may also disappear.
Attacks of supraventricular tachycardia are seen less fruqently.
Fibromas
32% of the patients have arrhythmias.
Ventricular tachycardia comprise 64% of the arrhythmias in these patients.
The morphology of ventricular tachycardia is related to tumor localization.
T wave changes may be seen.
References
Chou's Electrocardiography in Clinical Practice. Adult and Pediatric. 5th ed. Philadelphia. WB Saunders. 2001.
BMC Cardiovasc Disord 2018;18(1):142.
Cardiovascular Pathology 2012;21:120-127
J Am Coll Cardiol 2011;58:1903-1909.
International Journal of Cardiology 2008;130:e22-e24
Heart, Lung and Circulation 2001;10:30-34.
Rev Port Cardiol 2012;31:809-813.
ECG 1a. The ECG above belongs to a 1 year-old child. Echocardiography showed a mass of 50 mm in diameter involving the
inferior, posterior and lateral walls of the left ventricle. Holter examination detected accelerated idioventricular rhythm and
attacks of ventricular tachycardia. The patient is under Propranolol and Amiodarone therapy. The ECG above shows q waves
and negative T waves in inferior leads, and non-specific ST segment and T wave abnormalities in the lateral leads.
Pediatric Cardiologist Dr. Mahmut Gokdemir has donated the above ECG to our website.
Click here for a more detailed ECG
ECG 1b. Above is the same patient's ECG which was recorded 3.5 months later.
Even after 3.5 months, no significant changes have been observed in ST segment or the T wave.
Pediatric Cardiologist Dr. Mahmut Gokdemir has donated the above ECG to our website.
Click here for a more detailed ECG
ECG 1c. Above is the same patient's ECG which was recorded 1 year later.
Even after a year, no significant changes have been observed in ST segment or the T wave.
The low heart rate is due to Propranolol and Amiodarone treatment.
Pediatric Cardiologist Dr. Mahmut Gokdemir has donated the above ECG to our website.
Click here for a more detailed ECG
ECG 2. The ECG above belongs to a 13 years-old boy.
His ECHOcardiogram showed a tumor in the posterior mitral annulus.
PR interval is slightly prolonged (first degree AV block).
Pediatric Cardiologist Dr. Mahmut Gokdemir has donated the above ECG to our website..
Click here for a more detailed ECG
ECG 3. The ECG above belongs to a patient with biopsy proven left ventricular fibroma.
Anterior and lateral leads show negative T waves.
Dr. Barbara Vrandecic has donated the above ECG to our website.
Click here to see the Twitter link of this patient's ECHO video
Below is an image from this patient's ECHOcardiography examination:
Primary cardiac tumors are very rare.
Most cardiac tumors are secondary metastases from extracardiac sites.
ECG findings vary according to tumor localization.
Atrial tumors may show
- atrial arrhythmias (atrial fibrillation , atrial flutter, etc.)
- P wave or PR segment abnormalities
Tumors involving the AV node or
interventricular septum may show
- AV block
- bundle branch block
Tumors involving the ventricles may show
- ventricular arrhythmias (ventricular tachycardia, idioventricular rhythm, VPC, ventricular fibrillation)
- sudden cardiac death
- ST segment or T wave changes suggesting acute or old myocardial infarction
- non-specific ST segment or T wave changes
- ST segment elevation in right precordial leads (may mimick Brugada pattern)
- low voltage (due to destruction of the myocardium or pericardial effusion)
ECG findings and arrhythmias in frequently observed types of some cardiac tumors
Rhabdomyomas
The most frequent type of primary cardiac tumor.
Tuberous Sclerosis accompanies in most patients.
Arrhythmias are observed in 13% of the patients.
Ventricular tachycardia attacks are observed in 16%. As the tumor regresses in time, ventricular arrhythmias may also disappear.
Asymptomatic pre-excitation (WPW syndrome) may be seen. As the tumor regresses in time, pre-excitation may also disappear.
Attacks of supraventricular tachycardia are seen less fruqently.
Fibromas
32% of the patients have arrhythmias.
Ventricular tachycardia comprise 64% of the arrhythmias in these patients.
The morphology of ventricular tachycardia is related to tumor localization.
T wave changes may be seen.
References
Chou's Electrocardiography in Clinical Practice. Adult and Pediatric. 5th ed. Philadelphia. WB Saunders. 2001.
BMC Cardiovasc Disord 2018;18(1):142.
Cardiovascular Pathology 2012;21:120-127
J Am Coll Cardiol 2011;58:1903-1909.
International Journal of Cardiology 2008;130:e22-e24
Heart, Lung and Circulation 2001;10:30-34.
Rev Port Cardiol 2012;31:809-813.
ECG 1a. The ECG above belongs to a 1 year-old child. Echocardiography showed a mass of 50 mm in diameter involving the
inferior, posterior and lateral walls of the left ventricle. Holter examination detected accelerated idioventricular rhythm and
attacks of ventricular tachycardia. The patient is under Propranolol and Amiodarone therapy. The ECG above shows q waves
and negative T waves in inferior leads, and non-specific ST segment and T wave abnormalities in the lateral leads.
Pediatric Cardiologist Dr. Mahmut Gokdemir has donated the above ECG to our website.
Click here for a more detailed ECG
ECG 1b. Above is the same patient's ECG which was recorded 3.5 months later.
Even after 3.5 months, no significant changes have been observed in ST segment or the T wave.
Pediatric Cardiologist Dr. Mahmut Gokdemir has donated the above ECG to our website.
Click here for a more detailed ECG
ECG 1c. Above is the same patient's ECG which was recorded 1 year later.
Even after a year, no significant changes have been observed in ST segment or the T wave.
The low heart rate is due to Propranolol and Amiodarone treatment.
Pediatric Cardiologist Dr. Mahmut Gokdemir has donated the above ECG to our website.
Click here for a more detailed ECG
ECG 2. The ECG above belongs to a 13 years-old boy.
His ECHOcardiogram showed a tumor in the posterior mitral annulus.
PR interval is slightly prolonged (first degree AV block).
Pediatric Cardiologist Dr. Mahmut Gokdemir has donated the above ECG to our website..
Click here for a more detailed ECG
ECG 3. The ECG above belongs to a patient with biopsy proven left ventricular fibroma.
Anterior and lateral leads show negative T waves.
Dr. Barbara Vrandecic has donated the above ECG to our website.
Click here to see the Twitter link of this patient's ECHO video
Below is an image from this patient's ECHOcardiography examination: