Emergency presentation of emboli to multiple sites from an atrial myxoma
Emergency Department, Auckland City Hospital, Auckland, New Zealand. Emergency medicine Australasia: EMA
(Impact Factor: 1.3).
06/2012; 24(3):336-8. DOI: 10.1111/j.1742-6723.2012.01534.x
A middle aged man presented to our ED with back pain and confusion, had evidence of acute arterial insufficiency to his lower limbs and myocardial infarction on initial ECG. His workup included an urgent CT, which revealed a filling defect in his dilated left atrium, renal and splenic infarcts, and an embolism in his left internal iliac artery. Urgent embolectomy and fasciotomy could not save his left lower limb, and emergency cardiac surgery was required to excise an atrial myxoma. A brief narrative review of the literature is also presented, with this case being unusual in causing such widespread concurrent multiple organ damage, including stroke and myocardial infarct.
Available from: tgkdc.dergisi.org
- "Hypo-and/or akinesis of the ventricular wall was observed by echocardiography in 28 patients (45.9%), the inferior wall being the most frequently involved (Figure 2). Moreover, five patients (10.4%) had urgent coronary angiography[2,13,18,21,40]and one patient (2.1%) had urgent cardiac computed tomographydone for the diagnostic purpose of the coronary lesions. Of the 45 cardiac myxomas with a location reported, 42 (93.3%) "
Available from: Abdelhaleem Bella
- "Case No. Year 1st author Wall Site of coronary obstruction Age Sex 1 2012 Gordon Michael Nicholls  "
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ABSTRACT: Atrial myxomas are the commonest primary cardiac tumors and usually affect the left atrium. Patients with atrial myxomas present with intracardiac obstruction, embolization to the pulmonary and systemic circulation, or constitutional symptoms.
The coronary arteries’ involvement in myxomatous embolization, although rare, has been described to cause acute myocardial infarction (AMI). We report a case of atrial myxoma associated MI and present the clinical and echocardiographic features of this presentation followed by review of the English literature for the association of atrial myxomas and acute myocardial infarctions (AMI).
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Patients with occult, undiagnosed cardiac myxomas (CM) often present with acute complications that mimic other, more common, conditions. We describe two recently encountered patients who classically demonstrate this phenomenon and report the results of an integrative review of CM cases to define the characteristics of such patients.
A comprehensive 20-year review of reported cases that described patient-specific data of CM was performed. Using a standardized tool, the following elements were collected: age; gender; presenting symptoms and signs; diagnostic and management approaches; and outcomes.
126 cases of CM were identified. The mean patient age was 47.5 years (range 6–90). 70 (56%) were women. The most common mimic conditions initially being considered were cardiac complications, including acutely decompensated heart failure, myocardial infarction, dysrhythmia and sudden death (46%); systemic embolization, including cutaneous infarction and pulmonary embolism (23%); central nervous system embolization, including transient ischemic attack and acute stroke syndrome (22%); and constitutional conditions, such as fever, myalgia, arthralgia, fatigue and myxoma infections (17%). Echocardiography proved to be a readily available and accurate diagnostic test. The majority of reported patients experienced full recoveries after surgical intervention. Conclusions
CM is a rare but potentially life-threatening condition. Symptoms and signs relating to CM mimic other, more common conditions, resulting in diagnostic delay. Echocardiography can quickly and accurately diagnose CM and timely surgical intervention is curative. Clinician awareness of this condition, in a suggestive clinical context, will increase the likelihood of optimal patient outcome.
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