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Fever in Diseases of the Cardiovascular System
Published in Benedict Isaac, Serge Kernbaum, Michael Burke, Unexplained Fever, 2019
The initial features of atrial myxoma may resemble those of infective endocarditis. The blood cultures are persistently negative, and this is a major cause of “culture negative endocarditis”. Exceptionally, secondary infection can occur presenting a diagnostically confusing “culture positive” noninfective endocarditis.120 In contrast to infective endocarditis, splenomegaly is invariably absent.
Physiological interpretation of pressure waveforms
Published in John Edward Boland, David W. M. Muller, Interventional Cardiology and Cardiac Catheterisation, 2019
The haemodynamics of mitral stenosis may be mimicked by those of an atrial myxoma, a benign atrial tumour arising from the left atrial wall. The tumour may encroach on the mitral valve and cause obstruction to left ventricular inflow. At times, it is difficult to differentiate atrial myxoma from mitral stenosis if not clinically suspected. However, differences occur in the pulmonary artery wedge pressure, where mitral stenosis has a slow y descent and atrial myxoma a normal y descent. Also of note is that in left atrial pressure tracings, both a and v waves in mitral stenosis are increased but the x wave is slow (decreased dP/dt).
Practice Paper 7: Answers
Published in Anthony B. Starr, Hiruni Jayasena, David Capewell, Saran Shantikumar, Get ahead! Medicine, 2016
Anthony B. Starr, Hiruni Jayasena, David Capewell
Atrial myxoma, despite being relatively rare, is the most common tumour of the heart. It is a benign gelatinous neoplasm and is predominantly found attached to the septal wall of the left atrium by a pedicle. Symptoms include chest pain, dyspnoea, fever, lethargy and weight loss. Auscultation may reveal a loud first heart sound and a diastolic ‘plop’ due to prolapse of the tumour through the mitral valve. The presentation is similar to infective endocarditis and can cause diagnostic difficulties. Atrial myxomas can often embolize (with typical embolic consequences), but they do not metastasize. Echocardiography is the investigation of choice, and usually identifies a cystic polypoid mass. Treatment is by surgical excision. If removal is not complete, myxoma may recur.
Rhabdomyosarcoma from uterus to heart
Published in Journal of Community Hospital Internal Medicine Perspectives, 2020
Sohaib Roomi, Mahnoor Fatima Sherazi, Waqas Ullah, Omair Ali Khan, Artem Minalyan, Muhammad Atiq, Nishant Thalambedu
Cardiology Department was consulted. Initially, a presumptive diagnosis of atrial myxoma was made. Computed Tomography (CT) scan of the abdomen & pelvis revealed a 3 cm mass in the uterus. Biopsy of the uterine mass revealed it to be a rhabdomyosarcoma resembling an undifferentiated pleomorphic sarcoma (Figure 2). Pleomorphic cells with abundant mitosis and areas of necrosis were seen. At this point, atrial mass was presumed to be a myxoma and the cause of palpitations. As per Cardiology recommendation, It was excised and the mitral valve was repaired. Histological analysis of the atrial mass was consistent with the diagnosis of rhabdomyosarcoma (Figure 3). Histology of both atrial and uterine mass revealed a cellular malignant neoplasm composed of round to elongated markedly atypical cells enlarged with hyperchromatic nuclei and some cells with eosinophilic cytoplasm. Desmin positivity was observed on immunohistochemistry testing of uterine as well as the atrial mass. These findings, along with the patient’s clinical history, were consistent with the diagnosis of the rhabdomyosarcoma. After the surgical excision of the cardiac mass, the patient was scheduled for chemo/radiation therapy for uterine pathology. The patient stayed in the hospital for five days. She was discharged home and regular follow up was advised in the clinic with Gynecologic-Oncology, Cardiac Surgery, and Primary care Physician.
The use of point-of-care ultrasound in new-onset dyspnea: an unexpected diagnosis
Published in Acta Clinica Belgica, 2022
Emine Özpak, Loran Defruyt, Laura Braeckeveldt, Jens Czapla, Els Vandecasteele
The patient was admitted to the cardiology department for monitoring and further diagnostic work-up. Since a metastatic etiology could not be excluded at the moment of diagnosis, a CT scan of the abdomen was performed and tumor markers (carcinoembryonic antigen) were determined, which showed stable findings. A coronary angiogram did not show significant coronary artery disease and the patient was referred for urgent resection of the intracardiac mass through a minimally invasive surgical approach. The mass, with a size of 80 × 40 mm, was attached at the inferior part of the right inferior pulmonary vein (Figure 3). Cytological examination confirmed the diagnosis of atrial myxoma.
Natriuretic peptide-induced hyponatremia in a patient after surgical resection of a left atrial myxoma
Published in Acta Cardiologica, 2022
Alexander C. Andriessen, Sjaak Pouwels, Dharmanand Ramnarain
A 74-year old Caucasian female was admitted to the Intensive Care Unit (ICU) after resection of a large left atrial myxoma (4.3 by 4.5 by 3 cm). Her medical history showed mild hypertension and recently paroxysmal atrial fibrillation due to growth of her atrial myxoma. Prior to surgery, laboratory investigation showed a mild hyponatremia. She surgery a month later; after right atriotomy, the fossa ovalis with the stalked myxoma was resected. Figure 1 shows the intraoperative Trans Oesophageal Echocardiography (TEE) images of the atrial myxoma.