[A 70-year-old man with multiple injuries after a road accident: syncope with large right atrial tumour]

A 70-year old man caused a road accident without evidence for outer influence. He suffered from multiple injuries. An unstable chest required long-term mechanical ventilation. Recurrent depression of circulation and right heart failure complicated the course. Syncope could not be excluded as trigger of the accident.

There were all criteria of right heart failure. A stable circulation could only be established at high values of central venous pressure. The reason was a large right atrial myxoma, which nearly filled the whole right atrium and partially occluded the tricuspid valve. Coronary angiography demonstrated neovascularizations which arose from the left circumflex artery.

Immediate cardiac surgery was not possible because of the patient's bad general condition after the accident. The course was repeatedly complicated by hypotension and tachycardia. Only highly-normal central venous pressure values allowed stable circulation. Further complications were bilateral pleural effusion and small pulmonary embolism. As soon as possible the patient was referred to cooperating cardiac surgery for definite therapy. A tumor of 40 g, which inserted in the interatrial septum was removed. Histologic examination revealed myxoma.

In unclear syncope and suspicion of cardiac cause echocardiography should be performed. In the case of myxoma often the transthoracic view provides diagnosis. Hemodynamic problems in great myxoma make close-meshed monitoring of central venous pressure, systemic blood pressure and heart rate necessary. Soon cardiac surgery is recommended.