Abstract
IntroductionLeft atrial myxomas remain the most common benign primary cardiac tumors, and these cardiac growths can masquerade as mitral stenosis, infective endocarditis and collagen vascular disease. Atrial myxomas are found in approximately 14-20% of the population and can lead to embolization, intercardiac obstructions, conduction disturbances and lethal valve obstructions.Case presentationAn 84-year-old Hispanic man presented with complaints of dizziness upon standing, and with no prior history of heart murmurs, syncope, shortness of breath, or chest pain. Physical examination revealed evidence of orthostatic hypotension and a soft grade 1/6 systolic murmur at the left sternal border. A transthoracic echocardiogram revealed a large atrial myxoma occupying the majority of the left atrium, with the posterior border of the large atrial mass defined by eccentric mitral regurgitation identified during cardiac catheterization. Left atrial myxoma excision was performed, revealing a 7 × 6.5 × 4.5 cm atrial tumor attached to a 4 × 3 × 2 cm stalk of atrial septal tissue.ConclusionThis patient didn't present with the common symptoms associated with an atrial myxoma, which may include chest pain, dyspnea, orthopnea, peripheral embolism or syncope. Two-dimensional echocardiography provides substantial advantages in detecting intracardiac tumors. We recommend a two-dimensional echocardiogram in the workup of orthostatic hypotension of unknown etiology after the common causes such as autonomic disorders, dehydration, and vasodilative dysfunctions have been ruled out. By illustrating this correlation between orthostasis and an atrial myxoma, we hope to facilitate earlier identification of these intracardiac growths.
Highlights
Left atrial myxomas remain the most common benign primary cardiac tumors, and these cardiac growths can masquerade as mitral stenosis, infective endocarditis and collagen vascular disease
Left atrial myxomas account for 80% of all cardiac tumors
We present the case of an 84-year-old man with a large atrial myxoma, who presented with complaints of positional dizziness and who was found to have a grade 1/6 systolic murmur, and significant orthostatic hypotension
Summary
Two-dimensional echocardiography provides substantial advantages in detecting intracardiac tumors. Atrial myxomas are usually benign or asymptomatic, there is the possibility of diastolic embolization [7], conduction alterations and disturbances, and lethal valve obstructions occurring [4]. Since surgical excision has been reported to alleviate symptoms associated with cardiac myxomas, early identification and removal is preferable. By illustrating this correlation between orthostasis and atrial myxomas, we hope to facilitate earlier identification of these intracardiac growths. Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal
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