Massive Left Atrial Myxoma Presenting With Troponin-Positive Chest Pain
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CASE REPORT
Massive Left Atrial Myxoma Presenting With Troponin-Positive Chest Pain Aileen Kearney . Niall Corry . Ian B. A. Menown
Received: June 5, 2020 Ó The Author(s) 2020
ABSTRACT Atrial myxomas are the most prevalent primary cardiac tumors. The clinical presentation is variable and often poses a diagnostic challenge. Here we describe the case of a 52-year-old woman who presented with troponin-positive chest pain, exertional dizziness, and dyspnea as a consequence of a massive left atrial myxoma, which was successfully treated with surgical resection.
Keywords: Atrial myxoma; Cardiac tumor; Echocardiography; Systemic embolization
Key Summary Points Myxomas are the most common benign primary cardiac tumors. Clinical presentation can vary from an incidental finding to symptoms caused by cardiac obstruction, embolization, and constitutional upset. We observed a case of troponin-positive chest pain in a patient with a large left atrial myxoma due to coronary artery embolization, a rare but recognized complication. Urgent surgical resection is indicated to prevent embolic complications and sudden death.
Digital features To view digital features for this article, go to https://doi.org/10.6084/m9.figshare.12535400. Electronic Supplementary Material The online version of this article (https://doi.org/10.1007/s40119020-00187-2) contains supplementary material, which is available to authorized users. A. Kearney (&) I. B. A. Menown Department of Cardiology, Craigavon Cardiac Centre, Southern Trust, Craigavon, UK e-mail: [email protected] N. Corry Department of Pathology, Royal Victoria Hospital, Belfast, UK
INTRODUCTION Primary cardiac tumors are rare, with an estimated prevalence of 1 in 2000 [1]. Approximately 10% of primary cardiac tumors are malignant and 90% are benign. Myxomas represent the most common type of benign cardiac tumor and occur in the left atrium in 75–85% of cases. Clinical presentation can vary considerably and may include non-specific
Cardiol Ther
constitutional symptoms related to interleukin 6, thromboembolic events, or symptoms related to the obstructive effects of the tumor at the mitral valve orifice.
CASE PRESENTATION A 52-year-old woman with a past medical history of treated primary hyperthyroidism presented to the emergency department (ED) with episodes of dizziness and dyspnea on exertion, fatigue, arthralgia, and myalgia for several months. Cardiovascular risk factors included a family history of coronary artery disease and current smoking status. Clinical observations and electrocardiogram on arrival to ED were within normal limits. Initial high-sensitivity troponin T (hsTnT) was 4 ng/l (normal range \ 14 ng/l). Inflammatory markers including C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were within normal limits. While in the department, she developed central chest heaviness with dynamic anterolateral T-wave inversion on electrocardiogram. Repeat hsTnT, 3 h after presentation, was elevated at 83 ng/l. She was treated as a suspected acute coronary syndr
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