Angina pectoris: First manifestation of a left atrial myxoma

Abstract

Primary cardiac tumors are rare andmyxomas are themost common among them. In the majority of cases myxomas have a benign clinical progress, but it's possible for a coronary artery embolization, which is a potentially lethal complication [1–17]. We show the case of a man of 55 years, whounderwent to a cardiac check-up because of the presence, from the two past days, of angina pectoris. He suffers from arterial hypertension in pharmacological therapy, diabetes mellitus of recent diagnosis and a past episode of atrial fibrillation [18–28]. The ECG and the hematological tests were normal. Transthoracic echocardiography showed mild regurgitation and mild stenosis of the aortic and mitral valve and a mobile mass attached to the left atrial septum, which was difficult to define for the poor picture quality. Transesophageal echocardiography showed a left atrial mass arising from the atrial septum, compatible with the diagnosis of cardiac myxoma [29–33] (Fig. 1). The patient underwent coronary angiography that showed no major injuries. After that he underwent cardiac surgery to remove the tumor. In the followingmonths, therewere nomore symptoms of angina pectoris. We hypothesize that the clinical manifestation of angina is due to coronary embolization from the myxoma and not a phenomenon of coronary steal potentially induced by the rich vascularization of the mass. We think that because the patient had only a single, short lasting episode of angina. No presence of coronary emboli is justified that there was a tendency to spontaneous re-channeling of the obstructed coronary vessels, perhaps because of the tumors' tissue composition [14,15,17]. Also this case shows the potential lethality of cardiac myxomas.