An Elusive Cause of Syncope: The Case of a Right Ventricular Myxoma

Cardiac myxomas, the most common primary cardiac tumors, are benign tumors that arise from cardiac connective tissue. The most common site of origin is the left atrium, and occurrence at other sites is relatively rare. We present a case of a 19-year-old male, with a history of multiple episodes of syncope. The electrocardiogram showed right axis deviation, right ventricular hypertrophy with a strain pattern, and right bundle branch block. Echocardiography revealed multiple masses in the right atrium (RA) and right ventricle (RV) extending into the RV outflow tract (RVOT) and main pulmonary artery. The masses resulted in severe RVOT obstruction, which was the likely cause of recurrent syncope. The patient was referred for surgical excision. On histopathological examination, the mass was found to be a myxoma. The syncopal attacks resolved completely after resection of the mass, and he is asymptomatic on follow-up at 14 months. Cardiac myxomas arising in the right-sided cardiac chambers, though rare, can occur. When present, they may be multiple and may present with syncope due to RVOT obstruction. An early diagnosis and surgical excision are crucial for symptom relief and may be lifesaving. Histopathological examination is important in confirming the benign nature, for prognostication and for guiding further therapy.