Echocardiographic findings in cardiovascular emergencies: a multidisciplinary approach to intracardiac masses

Introduction: Atrial mixoma is the most common heart tumor in adult patients. It affects predominantly females, the predilect location being the left atrium. Although most of them are benign, the ability to remain asymptomatic for a long time and their embolic complications, can pose serious diagnosis issues.
Case presentation: We present the case of a 67 year old patient, directed to our service for acute chest pain, accompanied by electrocardiographic and enzymatic changes specific to an acute myocardial infarction. The patient’s history reveals permanent atrial fibrillation and brest cancer treated with chemotherapy. Echocardiography reveals a mild depression of systolic function in the context of left ventricular apical hypokinesia. Also a hyperechogenic, heterogeneous and extremely mobile mass could be seen in the left atrium. Given the symptoms, the patient had indcation to undergo a coronary angiography. The coronarography revealed no significant lessions, raising the hypothesis of an embolic myocardial infarction. The surgical evaluation indicated the excision of the tumoral mass at a later moment. The embolization of the entire formation with acute ischemia of the inferior limbs, precipitated the intervention. Emergency surgical embolectomy was performed with subsequent favorable evolution. The histopathological aspect pleaded in favor of the atrial mixoma.
Conclusions: Initial manifestation of an atrial mixoma, in the context of a myocardial infarction, is an unusual way of diagnosis. At the same time, the discovery of a tumor mass has led to additional confusion in the con-text of non-anticoagulated atrial fibrillation and neo-plasic hystory. Paradoxically, the final embolic compli-cation allowed an easier approach with a favorable end result.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)
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