From the Guidelines
The most specific signs and symptoms of cardiac myxoma include the classic triad of obstructive cardiac symptoms, embolic phenomena, and constitutional symptoms, with embolic symptoms being the most common presenting feature, occurring in about 30% to 40% of cases 1.
Key Symptoms
- Obstructive symptoms: dyspnea (especially when lying flat), dizziness, syncope, and heart failure symptoms that change with body position
- Embolic symptoms: strokes, myocardial infarction, or peripheral embolism, which can occur due to tumor fragments or associated thrombi breaking off and traveling to other organs
- Constitutional symptoms: fever, weight loss, fatigue, and laboratory abnormalities like elevated inflammatory markers (ESR, CRP) and anemia
Diagnostic Approach
Echocardiography, particularly transesophageal echocardiography, is the diagnostic technique of choice for characterization of cardiac myxoma, allowing for the localization and characterization of the tumor, including its location, attachment, size, appearance, and mobility 1.
Treatment
Prompt surgical removal is the definitive treatment for cardiac myxoma due to the risk of sudden cardiac death from complete obstruction or massive embolization, with surgical excision being recommended for symptomatic cases 1.
From the Research
Clinical Presentation of Cardiac Myxoma
The clinical presentation of cardiac myxoma can vary, but it often involves a triad of symptoms, including:
- Constitutional symptoms, such as fever, weight loss, and fatigue 2, 3
- Embolic symptoms, such as stroke or transient ischemic attack 2, 3
- Obstructive or cardiac symptoms, such as shortness of breath, chest pain, or palpitations 2, 3
Specific Signs and Symptoms
Some specific signs and symptoms of cardiac myxoma include:
- Tumor plop, a characteristic sound heard on auscultation 3
- Changes in physical findings with changing position 3
- Simulated mitral or tricuspid stenosis on precordial examination 3
- Systemic or pulmonary embolism 4
- Disturbances of ventricular and supraventricular rhythm 4
- Syncope 4
Diagnosis and Imaging
Cardiac myxoma can be diagnosed using various imaging modalities, including:
- Echocardiography, which is the first-line imaging technique 2, 3, 5
- Transesophageal echocardiogram, which has a high accuracy in diagnosing cardiac myxoma 5
- CT scan and cardiac MRI, which can provide additional diagnostic value 3, 5
- Histopathological examination, which can confirm the diagnosis of cardiac myxoma 2, 3