Atrial myxomas are a rare phenomenon and although benign, primary neoplasms of the heart can be burdensome depending on their location. Clinical symptoms are caused through a variety of mechanisms including conduction disturbances, obstruction, and valvular interference. Size and symptom development are strongly correlated and can almost always be detected by the use of echocardiography, magnetic resonance imaging or computed tomography. This is a case of a 62-year-old female with no significant past medical history presented to our facility with complaints of palpitations and associated dizziness for three months.
Atrial myxomas are the most common benign primary neoplasm of the heart, accounting for close to 80% of all cardiac tumors . Although quite rare, cardiac tumors in general can present with a multitude of symptoms that are closely correlated with their location . When symptoms are present, echocardiography and other imaging modalities almost always detect a lesion . When found in the left atria, manifestations include conduction disturbances, obstruction, and valvular interference owing to symptoms including dyspnea, orthopnea, cough, edema and fatigue. Given that clinical symptoms overlap with congestive heart failure and other cardiac abnormalities, accurate diagnosis is imperative for appropriate treatment and prognosis.
A 62-year-old female with no significant past medical history presented to our facility with complaints of palpitations and associated dizziness for three months. Prior work-up of her palpitations with Holter monitoring showed no irregularities. On arrival, she was in no acute distress and her palpitations had subsided. Vitals that were obtained were largely unremarkable except for a blood pressure of 142/77. Her EKG showed no acute irregularity and laboratory testing was within normal limits. On physical, a regular rate was observed, no murmurs, gallops or rubs were auscultated. She did not exhibit jugular venous distention or peripheral edema and other organ systems did not yield and irregularities.
The patient was admitted for further evaluation and a transthoracic echo was performed, revealing a 4.4 x 3.0-cm mass in the left atrium attached at the interatrial septum and aortomitral intervalvular fibrosa. Additional imaging studies including cardiac magnetic resonance imaging (MRI) and transesophageal echocardiography (TEE) were obtained for further confirmation of the mass and its location (Figures 1, 2). Surgical resection was planned, and pre-operative cardiac catheterization was performed which revealed mild prolapse of the mass causing intermittent obstruction of the mitral valve.
Published In/Presented At
Prousi G S, Moran J V, Biggs R G (February 19, 2019) Atrial Myxoma Presenting with Palpitations: A Case Report . Cureus 11(2): e4093. doi:10.7759/cureus.4093.
Cardiology | Internal Medicine
Department of Medicine, Department of Medicine Fellows and Residents