eMedicine Specialties > Oncology > Carcinomas of the Lung and Other Intrathoracic Carcinomas

Cardiac Neoplasms, Primary: Treatment & Medication

Author: Mary C Mancini, MD, PhD, Professor, Department of Surgery, Louisiana State University Health Sciences Center
Contributor Information and Disclosures

Updated: Aug 7, 2008

Treatment

Medical Care

For those tumors presenting with cardiac arrhythmias, standard medical management of the arrhythmia is warranted until the diagnosis is established and definitive therapy undertaken. In the case of paragangliomas, treat hypertension with beta-blockade until resection is undertaken.

Surgical Care

When possible, treatment of choice for cardiac tumors is complete resection.19 In patients whose tumors are determined to be malignant, adjuvant therapy (ie, chemotherapy, radiation) after resection did not affect the outcome.5 Cardiac transplantation has been used for benign and malignant tumors.20 Series using this therapy have been too small to use in predicting outcomes.

Medication

For patients who present with paraganglioma, hypertension, or arrhythmias, beta-blockade is the medical treatment of choice until surgical intervention can be undertaken.

Beta-blockers

This category of drugs has the potential to suppress ventricular ectopy due to ischemia or excess catecholamines. In the setting of myocardial ischemia, beta-blockers have anti-arrhythmic properties and reduce myocardial oxygen demand secondary to elevations in heart rate and inotropy.


Metoprolol (Lopressor)

Selective beta1 adrenergic receptor blocker that decreases automaticity of contractions. During IV administration, carefully monitor BP, heart rate, and ECG.

Adult

12.5-50 mg PO tid; increase at 1-wk intervals prn to total of 450 mg/d if necessary

Pediatric

1-5 mg/kg/d PO divided bid

Aluminum salts, barbiturates, NSAIDs, penicillins, calcium salts, cholestyramine, and rifampin may decrease bioavailability and plasma levels, possibly resulting in decreased pharmacologic effects; sparfloxacin, phenothiazines, astemizole, calcium channel blockers, quinidine, flecainide, and contraceptives may increase toxicity; may increase toxicity of digoxin, flecainide, clonidine, epinephrine, nifedipine, prazosin, verapamil, and lidocaine

Documented hypersensitivity; uncompensated CHF; bradycardia; asthma; cardiogenic shock; AV conduction abnormalities; chronic obstructive lung disease

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Beta-adrenergic blockade may reduce signs and symptoms of acute hypoglycemia and may decrease clinical signs of hyperthyroidism; abrupt withdrawal may exacerbate symptoms of hyperthyroidism, including thyroid storm; monitor patient closely and withdraw drug slowly; during IV administration, carefully monitor BP, heart rate, and ECG


Carvedilol (Coreg)

Nonselective beta-adrenoreceptor blocker with alpha-adrenergic blocking activity of equal potency. No intrinsic sympathomimetic activity has been documented.

Adult

3.125-12.5 mg PO bid

Pediatric

Not established

Interaction with other anti-arrhythmics and antihypertensives may potentiate clinical effect; may increase blood levels of cyclosporine and digoxin; may diminish hyperglycemic action of glucagon; may alter response to hypoglycemic agents (ie, sulfonylureas); fluoxetine and paroxetine may increase blood level; rifampin may decrease blood level; NSAIDs may blunt antihypertensive effect

Documented hypersensitivity; bradycardia; hypotension; severe cardiomyopathy; second- or third-degree heart block; chronic obstructive lung disease; symptomatic hepatic disease

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Monitor BP and pulse before taking; use with caution in CHF with slowed AV conduction, peripheral vascular disease, hyperthyroidism, or diabetes mellitus; discontinue if hepatic dysfunction occurs; avoid abrupt withdrawal; discontinue over 1-2 wk


Atenolol (Tenormin)

Selectively blocks beta1 receptors with little or no effect on beta2 receptors.

Adult

25-50 mg PO bid

Pediatric

1-2 mg/kg PO qd

Aluminum salts, barbiturates, calcium salts, cholestyramine, NSAIDs, penicillins, and rifampin may decrease effects; haloperidol, hydralazine, loop diuretics, and MAOIs may increase toxicity

Documented hypersensitivity; CHF; pulmonary edema; cardiogenic shock; AV conduction abnormalities; heart block (without pacemaker)

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Monitor BP and pulse before taking; beta-adrenergic blockade may reduce symptoms of acute hypoglycemia and mask signs of hyperthyroidism; abrupt withdrawal may exacerbate symptoms of hyperthyroidism and cause thyroid storm; monitor patients closely and withdraw drug slowly; during IV administration, carefully monitor BP, heart rate, and ECG

More on Cardiac Neoplasms, Primary

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Multimedia: Cardiac Neoplasms, Primary
References
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Further Reading

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Keywords

primary cardiac neoplasms, cardiac tumor, heart tumor, heart cancer, myxoma, Carney complex, atrial myxoma, intracardiac tumor mass, primary neoplasm, rhabdomyoma, fibroma, fibroelastoma, hemangioma, lipoma, teratoma, hamartoma, malignant tumor, benign tumor

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Contributor Information and Disclosures

Author

Mary C Mancini, MD, PhD, Professor, Department of Surgery, Louisiana State University Health Sciences Center
Mary C Mancini, MD, PhD is a member of the following medical societies: American Association for Thoracic Surgery, American College of Surgeons, American Surgical Association, Phi Beta Kappa, Society of Thoracic Surgeons, and Southern Surgical Association
Disclosure: Nothing to disclose.

Medical Editor

Clarence Sarkodee-Adoo, MD, Consulting Staff, Department of Bone Marrow Transplantation, City of Hope Samaritan BMT Program
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Benjamin Movsas, MD, Vice-Chairman, Department of Radiation Oncology, Fox Chase Cancer Center
Benjamin Movsas, MD is a member of the following medical societies: American College of Radiology, American Radium Society, and American Society for Therapeutic Radiology and Oncology
Disclosure: Nothing to disclose.

CME Editor

Rajalaxmi McKenna, MD, FACP, Consulting Staff, Department of Medicine, Southwest Medical Consultants, SC, Good Samaritan Hospital, Advocate Health Systems
Rajalaxmi McKenna, MD, FACP is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology, and International Society on Thrombosis and Haemostasis
Disclosure: Nothing to disclose.

Chief Editor

Jules E Harris, MD, Clinical Professor of Medicine, Division of Hematology/Medical Oncology, Department of Internal Medicine, University of Arizona College of Medicine at Tucson; Consulting Staff, Arizona Cancer Center
Jules E Harris, MD is a member of the following medical societies: American Association for Cancer Research, American Association for the Advancement of Science, American Association of Immunologists, American Society of Hematology, and Central Society for Clinical Research
Disclosure: GlobeImmune Salary Consulting; Amplimed Consulting fee Consulting

 
 
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