- Myxomas are the most common primary cardiac tumor.
- Atrial myxomas occur predominantly in females, with the peak between the fourth and sixth decade of life.
- Atrial myxomas are associated with a triad of complications:
- Obstruction
- Emboli
- Constitutional symptoms (such as fever, weight loss)
- Obstructive Symptoms
- Left-sided atrial myxomas
- Similar to signs and symptoms associated with mitral valve obstruction or regurgitation
- left-sided heart failure
- pulmonary hypertension
- most common symptom is:
- dyspnea with exertion followed by orthopnea
- paroxysmal nocturnal dyspnea
- Pulmonary edema.
- Right-sided atrial myxomas
- Similar to tricuspid stenosis and right heart failure
- Common symptoms include
- exertional dyspnea, Pedal edema, hepatomegaly, ascites.
- Left-sided atrial myxomas
- Thromboembolic Symptoms
- Due to the high systolic pressure and the location, left atrial myxomas were highly associated with increased risk of systemic embolization, particularly in the central nervous system, retinal arteries as well as viscera, spleen, kidneys, adrenals, abdominal aorta, iliac and femoropopliteal arteries.
- Constitutional Symptoms
- fever, malaise
- anorexia
- arthralgia
- weight loss
Evaluation
- Basic laboratory studies can show anemia, leukocytosis, thrombocytopenia, high erythrocyte sedimentation rate, and elevated gamma globulin.
- Echocardiography, cardiac magnetic resonance imaging (cardiac MRI), cardiac computed tomography (cardiac CT), PET scan, and coronary angiography are valuable evaluation tools.
Differential Diagnosis
- Mural thrombi
- primary sarcoma
- primary cardiac lymphoma
- large B-cell lymphoma
Prognosis
- The prognosis for patients undergoing surgical resection of atrial myxomas is excellent
- operative mortality rate does not exceed 5 percent
- recurrent rates are 1% to 3% in sporadic cases, 12% in familial cases, and 22% in complex atrial myxomas