Myocardial infarction in myxoma patients with normal coronary arteries. Case reports

Left atrial myxoma with biventricular dysfunction

Occurrence of left atrial myxoma with severe ventricular dysfunction without any obstructive coronary artery disease, as presented in our case, is very rare. It may be due to undiagnosed concomitant dilated cardiomyopathy or unknown cardiodepressant effect of myxoma which warrants further research.

Myxomas Causing Coronary Emboli Resulting in Acute Myocardial Infarction

A 26-year-old female presented with chest pain, numbness in the legs, and electrocardiographic signs of left ventricular aneurysm and recent myocardial infarction. Transesophageal echocardiography detected a mass in each atria. Angiography demonstrated normal coronary arteries, a left ventricular aneurysm, and an apical thrombus. At surgery, myxomas were excised from both atria and the aneurysm was plicated, followed by peripheral embolectomy. The patient made a good recovery.

Atrial myxoma masquerading as Takayasu's arteritis

We describe the case of a 48-year-old woman whose atrial myxoma was mistaken for vasculitis. The case report highlights the reasons why these two disorders may become confused, the dangers of initiating the wrong treatment and a simple means of avoiding misdiagnosis.

Left atrial myxoma: a rare nonatherosclerotic cause of acute myocardial infarction

Myocardial infarction from coronary artery embolism is a very rare but potentially lethal sequel of left atrial myxoma. Most atrial myxomas causing myocardial infarction are diagnosed retrospectively after a 2D echocardiogram is performed for assessment of myocardial function after a myocardial infarction. We present a relatively healthy 53-year-old male with anterolateral wall myocardial infarction and 100% occlusion at the proximal part of the obtuse marginal branch of the circumflex coronary artery that was subsequently reperfused. A 2D echocardiogram performed two days later revealed a left atrial mass, which was successfully resected and proven to be a myxoma. No recurrence of the tumor was seen on follow-up after four months. An automatic implantable cardioverter defibrillator was placed for residual ischemic cardiomyopathy with clinical improvement.

Cardiac myxoma induced paraneoplastic syndromes: a review of the literature

BACKGROUND

Atrial myxomas are the most common benign tumors of the heart and may present with a wide variety of symptoms. Although 45% of patients present with neurological symptoms, a diverse range of systemic symptoms also occur.

METHODS

A systemic review of the literature related to the diagnosis, treatment, pathogenesis, and symptoms associated with atrial myxomas was performed.

RESULTS

Here we summarize the current state of understanding about myxoma pathogenesis and treatments are described. We review the common and rare local and systemic effects of myxomas. Additionally, we review the paraneoplastic and metastatic potential of myxomas.

CONCLUSIONS

A better understanding of the diverse disease presentations, paraneoplastic syndromes, and side effects of cytokine abnormalities stemming from myxomas will aid the physician in earlier detection and monitoring of disease recurrence.

Left atrial myxoma associated with acute myocardial infarction and multiple cerebral infarctions: Report of a case

We report a case of left atrial myxoma associated with acute myocardial infarction (AMI) in a 63-year-old man. Percutaneous coronary intervention was performed immediately, and we removed white intracoronary particles by using a thrombectomy catheter. The postinterventional course was uneventful; however, on hospital day 5, pathological examination revealed platelet thrombus and myxomatous tissue from the particles aspirated by thrombectomy catheter, and transesophageal echocardiography showed a gelatinous mass in the left atrium. Based on these findings, we diagnosed AMI caused by coronary embolization from a left atrial myxoma, and excision of the myxoma was scheduled. However, preoperative magnetic resonance imaging revealed multiple subacute cerebral infarctions, and the tumor was successfully excised on hospital day 13. Although coronary embolization induced by cardiac myxoma is rare, it should be considered in a young to middle-aged patient presenting with signs of AMI without coronary risk factors.

Clinical presentation and investigation findings in cardiac myxomas: new insights from the developing world

BACKGROUND

Cardiac myxomas are an uncommon condition and most of the available information on their clinical features comes from smaller series of patients from developed countries. Our aim was to quantify and correlate the clinical and investigation findings in cardiac myxomas in a developing country and compare them with existing data.

METHODS

A retrospective study of case notes, electrocardiograms, and x-rays of 171 patients treated for cardiac myxoma from February 1992 to October 2006 at a large charitable institution in South India was conducted. Frequency of different clinical findings and relationships between these findings, age, sex, tumor location, and size were calculated.

RESULTS

The mean age at presentation was 37.1 years. Dyspnea was the most common symptom. Embolism was found in 9% of patients and systemic symptoms in 20% of patients. Auscultation abnormalities were present in 89% of patients, including a tumor plop in 50%. Left atrial enlargement was the most common electrocardiographic abnormality (35%), whereas cardiomegaly was the most common chest x-ray finding (55%). Raised erythrocyte sedimentation rate was found in 75% and anemia in 45% of patients. Female patients and patients with right atrial myxomas more commonly had systemic symptoms. Tumor size correlated with electrocardiographic and x-ray abnormalities.

CONCLUSIONS

Cardiac myxomas present at a younger age in developing countries. Almost all patients were symptomatic because they presented for medical care at an advanced stage of disease. Certain clinical manifestations depend on site and size of the tumor as well as age of the patient. A high index of suspicion is necessary for making an early diagnosis.

Coronary angiography of cardiac myxoma

BACKGROUND

Myxoma usually presents with nonspecific symptoms. Preoperative coronary angiography is presently only considered if patients are at increased risk of coronary artery disease (CAD). The angiographic patterns of cardiac myxoma have not been fully described.

HYPOTHESIS

The aim of our study was to investigate coronary angiograms as well as patterns of tumor vascularity in patients with cardiac myxoma.

METHODS

From January 1990 to December 2003, 33 patients with cardiac myxoma, who had received surgical resection at our hospital, were enrolled; of these, 9 patients underwent preoperative coronary angiography. The severity and extent of coronary artery stenosis, as well as tumor angiographic patterns, were analyzed. Coronary artery disease is defined as a > 50% stenosis in diameter at any segment of the coronary artery viewed by two orthogonal views on cineangiogram.

RESULTS

Four (44.4%) patients showed concomitant CAD. The presence of coronary risk factors was not different between patients with and without CAD. Contrast media-enhanced tumor vasculature was found in five (55.6%) patients. Four (80%) patients had multiple feeding arteries. There was the characteristic "sea anemone" appearance of the tumor vasculature composed of (1) basal vascular network, (2) vessel stem, (3) backbone branches, and (4) dye brushes. These findings were characteristic of cardiac myxoma.

CONCLUSION

Coronary angiography can detect the concomitant coronary disease and the unique vascular appearances of cardiac myxoma. Familiarity with the "sea-anemone" angiographic findings may help in the diagnosis of cardiac myxoma.

MPO-ANCA-associated pseudovasculitis in cardiac myxoma

We describe a case of cardiac myxoma whose clinical presentation mimicked that of polyarteritis nodosa. The serum levels of MPO-ANCA and IL-6 were elevated on laboratory investigation and normalized after the removal of the tumor. We suggest that a 'true' vasculitic mechanism contributes to the pathogenesis of pseudovasculitis in cardiac myxoma.

[Left auricle myxoma, a rare cause of myocardial infarction]

INTRODUCTION

The association of left auricle myxoma and myocardial infarction is exceptional. Nevertheless, a causal relationship exists between the 2 affections.

OBSERVATION

A 54 year-old woman was hospitalised in a rush for myocardial infarction. Sonography revealed a voluminous tumoral formation in the left auricle. The diagnosis of myxoma was confirmed by the anatomopathological examination.

DISCUSSION

Although systemic embolism represents the most frequent causal link between left auricle myxoma and myocardial infarction, hypercoagulability is another possible cause. This can be explained by the secretion of interleukins 6 and 8 by the myxoma.

Myocardial infarction with normal coronary arteries: the pathologic and clinical perspectives

Myocardial infarction with normal coronary arteries is a syndrome resulting from numerous conditions but the exact cause in a majority of the patients remains unknown. Cigarette smokers and cocaine users are more prone to develop this condition. The possible mechanisms causing myocardial infarction with normal coronary arteries are hypercoagulable states, coronary embolism, an imbalance between oxygen demand and supply, intense sympathetic stimulation, non-atherosclerotic coronary diseases, coronary trauma, coronary vasospasm, coronary thrombosis, and endothelial dysfunction. It primarily affects younger individuals, and the clinical presentation is similar to that of myocardial infarction with coronary atherosclerosis. Thrombolytics, aspirin, nitrates, and beta blockers should be instituted as a standard therapy for acute myocardial infarction. Once normal coronary arteries are identified on subsequent angiography, the calcium channel blockers could be added since coronary vasospasm appears to play a major role in the pathophysiology of this condition. The beta blockers should be avoided in cocaine-induced myocardial infarction because the coronary spasm may worsen. In myocardial infarction with normal coronary arteries, complications such as malignant arrhythmia, heart failure, and hypotension are generally less common, and prognosis is usually good. Recurrent infarction, postinfarction angina, heart failure, and sudden cardiac death are rare. Stress electrocardiography and imaging studies are not useful prognostic tests and long-term survival mainly depends on the residual left ventricular function, which is usually good.