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Cardiac Myxoma With Unusual Obstructive and Embolic Presentations: Concurrent Stroke and Angiography-Negative
Robert Jeen-Chen Chen1, Hsin-Hua Chou, Kuei-Ton Tsai
1From the Division of Cardiovascular Surgery (RJ-CC, K-TT, T-CS, C-YH), Department of Surgery; and Division of Cardiology (H-HC), Department of Internal Medicine, Taipei Tzuchi Hospital, Buddhist Tzuchi Medical Foundation, New Taipei City, Taiwan.
Insights
A rare cardiac myxoma mimicked heart attack and stroke, highlighting the need for echocardiography. Early surgery is crucial for managing this condition and preventing complications.
Area of Science:
- Cardiology
- Neurology
Background:
- Cardiac myxoma is a rare tumor, often presenting with nonspecific symptoms.
- Atypical presentations can delay diagnosis and treatment.
Observation:
- An elderly woman presented with stroke and myocardial infarction symptoms, but coronary angiography was negative.
- Focused cardiac ultrasound revealed a left atrial myxoma causing mitral valve obstruction.
Findings:
- The patient developed respiratory distress and shock, necessitating emergent surgery.
- Postoperative MRI showed cerebellar infarcts, indicating embolic events from the myxoma.
Implications:
- This case underscores the importance of considering cardiac myxoma in the differential diagnosis of unexplained neurological and cardiac events.
- Basic echocardiography is vital for diagnosing cardiac myxoma, especially in perplexing cases.
- Timely surgical resection of cardiac myxoma is essential for favorable outcomes.
Abstract:
We present a case of cardiac myxoma with atypical presentations of concurrent stroke and angiography-negative myocardial infarction. The case emphasizes the importance of basic echocardiography and timely surgery in the management of cardiac myxoma. An elderly woman presented to the emergency department in an unconscious state. Electrocardiogram and elevated cardiac enzymes suggested acute myocardial infarction; however, immediate coronary angiography proved patency. Basic echocardiography revealed an oscillating left atrial myxoma obstructing inflow through the mitral valve. After regaining consciousness while in the intensive care unit, the patient developed respiratory distress and shock, and emergent en bloc resection was performed. Ataxia was noted in her postoperative course and multiple small cerebellar infarcts were found on magnetic resonance imaging. After a 1-month period of rehabilitation, the patient recovered well and continues to be followed as an outpatient. Cardiac myxoma requires timely management and may be missed if not included in the differential diagnoses. Basic echocardiography, also called focused cardiac ultrasound, may aid in the diagnosing of perplexing cardiac cases.
