Intermittent Diplopia and Dyspnea: The Subtle Face of a Cardiac Myxoma

Cardiac myxomas are rare primary cardiac tumors that present with clinical features that mimic a broad range of pathology; therefore, understanding the manifestations of the disease is essential for prompt diagnosis. In this case, a 53-year-old male presented after an episode of presyncope, with a six-month history of diplopia, diffuse finger and toe pain, exertional shortness of breath, cyclical fevers, and fatigue. It is a subtle, nonspecific presentation more suggestive of rheumatological or neurological disease than a primary cardiac pathology. MRI of the brain showed no acute pathology, but further workup revealed elevated inflammatory markers, pulmonary congestion, and rSr' pattern on EKG, suggesting possible right ventricular (RV) strain or conduction system disease. To evaluate for structural heart disease causing presyncope, an echocardiogram revealed a left atrial mass that was excised with resolution of symptoms.