A Case of Large Left Atrial Myxoma Presenting as Atrial Flutter

Abstract

Case A 41-year-old man presented with palpitation and dyspnea on exertion for 3 days. He had no history of diabetes, hypertension and smoking. He felt mild dyspnea 3 years ago, but ignored it. Initial vital signs were: blood pressure of 110/70 mmHg, heart rate of 162 beats/min, and respiratory rate of 20 breaths/min. On physical examination, heart murmurs were rarely audible due to rapid heart rate and other findings were unremarkable. On laboratory findings, BNP level was 445 pq/ml, and CRP level was 3.4 mg/dl (reference range 0-1 mg/dl). The initial electrocardiogram (ECG) revealed atrial flutter with 4:1 AV block and 75 beats/min of ventricular rate (Fig. 1). After 30 minutes, the patient’s blood pressure dropped to 90/60 mmHg and the heart rate rose to 150-160 beats/min on ECG monitoring. We performed trans-thoracic echocardiography (TTE) for evaluation of dyspnea, which revealed a large round mobile mass in the left atrium (Fig. 2). The mass was so large that it nearly obliterated the left