Acute decompensated heart failure refractory to treatment in a patient with giant atrial myxoma A case report.

Abstract

Introduction: Primary cardiac tumors occur in 10-30 cases per 100,000 inhabitants, 75% of which are benign, and cardiac myxomas account for 50% of this type of tumor. The objective of this case report is to present an unusual case where the clinical presentation of cardiac myxoma, known as the "great imitator," has nonspecific clinical findings depending on the location and size of the tumor, presenting obstructive, systemic, and embolic signs and symptoms that mimic various pathologies, which could delay diagnosis.

Case Report:

A 48-year-old woman with a history of hypertension presented with a 2-week history of progressive dyspnea and cough, progressing to orthopnea. She also reported autonomic symptoms and a sense of impending doom. Physical examination revealed hypertension, tachypnea, bilateral diffuse crackles, and decreased breath sounds at the bases, hyperdynamic precordium with a soft mitral systolic murmur radiating to the axilla, jugular venous distension, hepatomegaly, and bilateral lower extremity edema. Chest X-ray showed acute pulmonary edema and bilateral pleural effusion. Echocardiography revealed a giant left atrial mass affecting mitral valve opening with a high risk of rupture and embolization. Isolated episodes of ventricular tachycardia were observed on monitoring. The patient underwent surgery, and a 55x35x47mm mass was excised without complications. The pathological diagnosis was an atrial myxoma. At 6-month follow-up, the patient was in clinical remission with no recurrence on echocardiography.

Conclusion:

In this case, echocardiography was indispensable for the diagnosis. The myxoma caused atrioventricular obstruction, mimicking severe mitral stenosis, leading to decompensated heart failure refractory to medical treatment. Early surgical excision was the definitive treatment to prevent complications such as embolism, syncope, heart failure, and sudden death.