Abstract
Left atrial myxomas are rare tumors that arise in the left atrium of the heart. As they become larger, they tend to grow into the atrial lumen and disrupt cardiac hemodynamics. Commonly reported symptoms include dyspnea, orthopnea, cough, peripheral edema, and fatigue. On physical examination, a characteristic “tumor plop” may be heard in some patients early in diastole. Left atrial myxomas may cause emboli to be released into the systemic circulation, which can lead to acute cardiovascular events, including strokes. We present the case of a 43-year-old female with sudden-onset slurred speech, left facial droop, and left-sided hemiplegia. CT angiography of the brain revealed a right middle cerebral artery infarct, and the patient underwent emergent mechanical thrombectomy. Upon workup for secondary causes of stroke, echocardiogram revealed an incidental 8 cm left atrial myxoma. After stabilization in the ICU, the patient was taken to surgery and the tumor was successfully removed. Over the course of admission, the patient’s left-sided hemiplegia gradually improved, and she was eventually transferred to inpatient rehabilitation care. A multidisciplinary effort involving medicine teams, neurology, cardiology, cardiothoracic surgery, neuro-interventional radiology, pain management, and endocrinology was essential in reaching the diagnosis. This case highlights the importance of considering a primary cardiac tumor such as a left atrial myxoma in the differential diagnosis when evaluating for secondary causes of acute ischemic stroke.
Highlights
Primary cardiac tumors are rare with an incidence as low as 0.03%, and 75% of which are benign
Cardiac myxomas are the most common primary cardiac tumor, with around 70% presenting in the left atrium (LA) [3, 11]
Iyer et al reported a similar case of a patient with left atrial myxoma presenting with ischemic stroke who was having symptoms of palpitations for a year prior to diagnosis [11]
Summary
Primary cardiac tumors are rare with an incidence as low as 0.03%, and 75% of which are benign. Left atrial myxomas are relatively benign primary cardiac tumors with an incidence rate of 0.5% per million per year [1]. Patient reported a recent history of mild chest pain and shortness of breath when walking She had a cardiologist but has not had an echocardiogram or stress test performed. Cardiac workup included an echocardiogram, which illustrated an enormous left atrial myxoma with normal left ventricle function (Figure 3). Surgical intervention was successful in removing the myxoma in its entirety and in repairing a small atrial septal defect at the level of the fossa ovalis (Figure 4). The patient’s blood glucose stabilized and did not require further intervention She was stable and was transferred to the medical floor with telemetry monitoring on postoperative day 5. Patient was discharged to an acute rehab center to continue her recovery
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