Sudden death due to cardiac myxoma

Primary tumours of the heart are rare, their incidence ranging from 0.0017 to 0.28 per cent in various autopsy series (Colucci and Braunwald, 1992). Thirty per cent of these tumours are cardiac myxomas (McAllister and Fenaglio, 1978). The latter are histologically benign but potentially lethal. Sudden death is reported in 15 per cent of cases and is mainly attributed to massive embolism or mechanical interference to blood flow within the heart by the tumour (Fisher, 1983). This incidence could be due to the absence of clinical manifestations of the disease or to the presence of non-specific or subtle ones that preclude early referral for specialist evaluation (Colucci and Braunwald, 1992). Such a poor prognosis is not altogether justified, however, considering the highly sensitive and accurate diagnostic techniques and the level of surgical treatment which can be offered today (Larsson et al., 1989; Roberts, 1989; Bortolloti et al., 1990; Lyons et al., 1991). We present a case diagnosed at post-mortem of an atrial myxoma which had subtle ante-mortem manifestations. This paper should alert the clinician with regard to the need to be aware of the rather obscure clinical presentation which may accompany this potentially treatable condition.