Cardiac papillary fibroelastoma presenting with acute coronary syndrome and syncope

Area of Science:

• Cardiology
• Cardiac Pathology
• Oncology

Background:

• Cardiac papillary fibroelastomas (CPFs) are the most common primary cardiac tumors, often found incidentally on valves.
• While frequently asymptomatic, CPFs can lead to severe embolic events, myocardial infarction, syncope, and sudden death.

Observation:

• A 70-year-old female presented with syncope and chest pain, initially diagnosed as acute coronary syndrome without ST elevation.
• Transthoracic echocardiography revealed a pedunculated mass on the aortic valve.
• Cardiac catheterization showed normal coronary arteries, suggesting an alternative etiology for her symptoms.

Findings:

• Surgical excision of the aortic valve mass was performed.
• Histological examination confirmed the mass as a cardiac papillary fibroelastoma (CPF).

Implications:

• Symptomatic CPFs, like the one causing acute coronary syndrome and syncope in this patient, are effectively treated with surgical excision.
• This case underscores the importance of considering cardiac tumors in the differential diagnosis of unexplained cardiac events, even in the absence of typical coronary artery disease.
• Early diagnosis and surgical intervention for symptomatic CPFs offer a curative outcome and prevent potentially fatal embolic complications.