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[A case of cardiac tumor found during examination in orthostatic hypotension]
G Takemura1, H Kotoura, A Nishioka
1First Division, Department of Internal Medicine, Wakayama Red Cross Hospital.
Insights
A 61-year-old man with orthostatic hypotension was diagnosed with a left atrial myxoma. Surgical removal of the cardiac tumor resolved his symptoms and improved blood pressure.
Area of Science:
- Cardiology
- Oncology
Background:
- Orthostatic hypotension can be a rare symptom of intracardiac tumors.
- Left atrial myxoma is a primary cardiac tumor, often benign.
Observation:
- A 61-year-old male presented with a 2-year history of orthostatic dizziness and severe hypotension (BP 64/40 mmHg when sitting).
- Echocardiography revealed a 3.5 cm left atrial myxoma obstructing the left ventricular inflow, particularly in the sitting position.
- The myxoma was attached to the postero-inferior wall of the left atrium.
Findings:
- Surgical resection of the left atrial myxoma was successfully performed.
- Post-operatively, the patient's orthostatic hypotension and dizziness resolved completely.
- Blood pressure normalized (e.g., 98/64 mmHg when sitting) after tumor removal.
Implications:
- This case highlights left atrial myxoma as a treatable cause of orthostatic hypotension.
- The specific attachment site of the myxoma may influence symptom severity and presentation.
- The observed positional worsening of obstruction provides unique echocardiographic insight into cardiac tumor hemodynamics.
Abstract:
We report a case of left atrial myxoma found when examination was made for the cause of orthostatic hypotension. The case was that of a man of 61 years of age. For the previous 2 years, the man had felt dizzy only at the standing or sitting position. The blood pressure was 90/50 at recumbency and 64/40 at the sitting position. Echocardiographic study revealed a left atrial tumor, which fell into the left ventricular cavity and prevented the blood from filling the left ventricular cavity. This effect was more severe at the sitting position than at recumbency. Resection of the tumor was carried out. It was a myxoma with a diameter of 3.5 cm with a stalk adhering to the postero-inferior wall of the left atrium. After the removal of the tumor, the patient's complaint and orthostatic hypotension disappeared; blood pressure was 102/60 at recumbency and 98/64 at sitting position. Orthostatic dizziness has been reported in some cases as one of the symptoms of the intracardiac tumor. But the state of aggravation at the sitting position has never been observed during actual echocardiographic study. The myxoma adhered to the postero-inferior wall of the left atrium, which site might be associated with the symptom (orthostatic hypotension).