Cardiogenic Shock Due to Atrial Myxoma With Mitral Valve Involvement

Despite being the most common primary cardiac neoplasm, the incidence of cardiac myxomas remains low. The majority of myxomas usually have a nonspecific presentation often leading to symptoms such as cough, dyspnea, and weakness. Larger tumors may cause arrhythmia, syncope, or cerebrovascular events due to embolization. Rarely, patients with myxomas may present with signs and symptoms of cardiogenic shock. A 50-year-old female presented to our Emergency Department with an altered mental status and hypotension. Initial imaging of the patient's head showed an embolic infarction. Subsequent investigations revealed a large atrial mass protruding through the mitral valve. The patient was initially resuscitated and then taken to the operating room emergently where the mass was removed. Postoperatively, she was observed in the intensive care unit and eventually transferred to a step-down unit. Her pathology report confirmed that the mass was a cardiac myxoma. Here, we report the case of a patient with an atrial myxoma protruding through the mitral valve who presented in cardiogenic shock. The etiologies of cardiogenic shock and atrial myxomas are explored. The medical and surgical management of a patient with an atrial myxoma presenting in cardiogenic shock is reviewed. We reflect on our diagnostic evaluation, determining that patients who present in undifferentiated cardiogenic shock should be approached with a broad differential diagnosis.