Rare Right Ventricular Obstructing Myxoma: An Incidental Finding for a Common Symptom

Background: Palpitations are a common clinical manifestation within the general population and are often associated with conduction abnormalities within the heart. Structural causes account for only 3% of palpitations. As such, they are often investigated with cardiac event/Holter monitoring. Presented here is a case of palpitations secondary to intracardiac mass. Case summary: A 58-year-old female patient presented with palpitations. The electrocardiogram was unremarkable. Transthoracic echocardiography revealed a large, mobile mass visualised in the right ventricular outflow tract. Further investigations, including cardiac CT and cardiac MRI, confirmed a right ventricular myxoma, which was successfully surgically excised. There has been no evidence of recurrence or long-term morbidity. Discussion: Myxomas are extremely rare and most commonly present with signs of heart failure, thromboembolic events, or constitutional symptoms. Palpitations are a usual presentation of cardiac masses. Myxomas carry a high risk of sudden death through thromboembolic events or dysrhythmias, therefore immediate intervention is essential. From the findings, patients presenting with palpitations are recommended to undergo a transthoracic echocardiogram to identify the possibility of palpitations secondary to structural variants or abnormalities. Learning Points: If there are no haematological or biochemistry abnormalities, and no risk factors for palpitations were ascertained, patients presenting with palpitations should ideally have a transthoracic echocardiogram, in addition to Holter monitoring, to rule out a structural cause for their clinical manifestation. Structural abnormalities noticed on echocardiography are better characterised with cardiac MRI as it provides both structural and possible tissue characterisation.