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Metastases to the heart.

Primary tumors of the heart are rare, occurring at a frequency of ∼0.02% in pooled autopsy series [1]. Histologically, three-quarters of primary heart tumors turn out to be benign, almost half of them being myxomas [2]. Whether benign or malignant, the majority of primary cardiac tumors are intracavitary and preferentially develop in the left atrium, thereby leading to left ventricular inflow obstruction. Embolism is also common. Secondary or metastatic heart tumors occur comparatively more frequently, with an at least 100 times higher incidence than primary tumors of the heart [3]. Intracavitary growth of secondary heart tumors, however, is unusual. Therefore, despite their frequency, metastatic heart tumors only rarely gain clinical attention. However, signs of cardiac involvement are often overlooked, since the symptoms of disseminated tumor disease prevail. Thus, like primary tumors of the heart, metastases may imitate valvular heart disease or cause cardiac failure, ventricular or supraventricular heart rhythm disturbances, conduction defects, syncope, embolism, or, quite often, pericardial effusion. Not infrequently, cardiac tumor invasion contributes to the mechanism of death in affected patients [4]. Today, two-dimensional echocardiography makes the detection of cardiac involvement in neoplastic diseases much easier.