Systemic Embolization and Myocardial Infarction due to Clinically Unrecognized Left Atrial Myxoma

Myxomas are the most common primary tumors of the heart. We report an extraordinary severe case of left atrial myxoma, presenting with stroke, myocardial infarction, and multiple arterial embolism including aorta, splenic and renal arteries, and several peripheral arteries. The patient had previously been diagnosed with systemic vasculitis, a typical but less common finding caused by multiple emboli mimicking vasculitis. The myxoma was removed and atrial septum reconstruction was performed. In summary, early diagnostic differentiation of myxoma from vasculitis is critical, and immediate surgical removal of myxoma is required as the probability of thromboembolic complications increases over time.

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Giant left atrial myxoma presenting as cerebral embolism

Journal of Surgical Arts ◽

10.14717/jsurgarts-210209 ◽

2021 ◽

pp. 93-97

Keyword(s):

Left Atrial ◽

Heart Diseases ◽

Atrial Myxoma ◽

Cerebral Stroke ◽

Primary Tumors ◽

Mortality And Morbidity ◽

Left Atrial Myxoma ◽

Cardiac Neoplasms ◽

Systemic Embolization ◽

Rheumatic Heart

Primary cardiac neoplasms are uncommon with an overall incidence of 0.0017 to 0.02%. The majority of these tumors are benign and half of these tumors are myxomas. About 75% of them are located in the left atrium. Acute embolic cerebral stroke is major problem with increased mortality and morbidity. Embolus arising from cardiac origin costitutes about 20% of ischemic strokes. Atrial fibrillation is cause of more than 50% of cardiogenic emboli. Congenital heart diseases, such as atrial septal defect, patent foramen ovale, prosthetic and rheumatic heart valvular disease, dilated cardiomyopathy and endocarditis are predisposing factors for cardiogenic emboli. Emboli from primary tumors of the heart are extremely rare, with an incidence of 0.02 %. Myxoma is a potential source of systemic embolization to the brain or peripheral arteries. Thus, cerebral stroke may be the first manifestation of the presence of left atrial myxoma.

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Coronary Embolization from a Left Atrial Myxoma Containing Malignant Lymphoma Cells

Texas Heart Institute Journal ◽

10.14503/thij-14-4619 ◽

2015 ◽

Vol 42 (6) ◽

pp. 565-568 ◽

Cited By ~ 5

Author(s):

Andrés M. Pineda ◽

Christos G. Mihos ◽

Francisco O. Nascimento ◽

Orlando Santana ◽

Joseph Lamelas ◽

...

Keyword(s):

Myocardial Infarction ◽

Left Atrial ◽

B Cell Lymphoma ◽

Atrial Myxoma ◽

St Segment Elevation ◽

Left Atrial Myxoma ◽

Systemic Embolization ◽

Coronary Embolization ◽

Obtuse Marginal Branch ◽

Obtuse Marginal

Systemic embolization from a primary cardiac tumor is a relatively frequent presentation. However, an acute myocardial infarction due to coronary embolization is rarely seen. We offer an unusual case of a 50-year-old man who presented with severe angina and was diagnosed with an inferolateral ST-segment-elevation myocardial infarction. Aside from otherwise healthy coronary arteries, his coronary angiogram revealed an acute occlusion of the first obtuse marginal branch, which was treated with balloon angioplasty. Because no residual plaque or dissection was found after the angioplasty, an embolic source was suspected. An echocardiogram then revealed a large mobile left atrial myxoma prolapsing into the left ventricle, so the patient underwent minimally invasive resection. Detailed pathologic examination of the myxoma revealed a concomitant high-grade B-cell lymphoma.

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Cerebral embolism due to left atrial myxoma in a patient presenting with chest pain and ST-segment elevation: a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytaa272 ◽

2020 ◽

Author(s):

António Fontes ◽

Nuno Dias-Ferreira ◽

Anabela Tavares ◽

Fátima Neves

Keyword(s):

Myocardial Infarction ◽

Chest Pain ◽

Magnetic Resonance ◽

Left Atrial ◽

Left Ventricular ◽

Atrial Myxoma ◽

Left Atrial Myxoma ◽

St Segment ◽

Wide Range ◽

St Elevation

Abstract Background Myocarditis is an uncommon, potentially life-threatening disease that presents with a wide range of symptoms. In acute myocarditis, chest pain (CP) may mimic typical angina and also be associated with electrocardiographic changes, including an elevation of the ST-segment. A large percentage (20–56%) of myxomas are found incidentally. Case summary A 62-year-old female presenting with sudden onset CP and infero-lateral ST-elevation in the electrocardiogram. The diagnosis of ST-elevation myocardial infarction was presumed and administered tenecteplase. The patient was immediately transported to a percutaneous coronary intervention centre. She complained of intermittent diplopia during transport and referred constitutional symptoms for the past 2 weeks. Coronary angiography showed normal arteries. The echocardiogram revealed moderate to severe left ventricular systolic dysfunction due to large areas of akinesia sparing most of the basal segments, and a mobile mass inside the left atrium attached to the septum. The cardiac magnetic resonance (CMR) suggested the diagnosis of myocarditis with concomitant left atrial myxoma. The patient underwent resection of the myxoma. Neurological evaluation was performed due to mild vertigo while walking and diplopia in extreme eye movements. The head magnetic resonance imaging identified multiple infracentimetric lesions throughout the cerebral parenchyma compatible with an embolization process caused by fragments of the tumour. Discussion Myocarditis can have various presentations may mimic acute myocardial infarction and CMR is critical to establish the diagnosis. Myxoma with embolic complications requires emergent surgery. To the best of our knowledge, this is the first case reported in the applicable literature of a myxoma diagnosed during a myocarditis episode.

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