Echocardiography Study and Variability of Symptoms of the Cardiac Myxoma Concerning Three Cases in a Period of Six Months

*Rodolfo Vega Candelario

*Assistant professor of Medical Sciences, Ciego de ávila University.Head of Cardiology services at Roberto Rodríguez, Moron Hospital; Ciego de

ávila, Cuba

First Patient

Title: Variability of Symptoms of Cardiac

Myxoma: About A Case

Keywords

Myxoma; Variability of Symptoms; Complications

Introduction

Until a few decades ago the pre-mortem diagnosis

of a cardiac tumor was very difficult, the vast majority of

observations.

They were autopsies and the interest this pathology

had for the physician was purely academic. From the

1970s, with the introduction of echocardiography and the

development of cardiac surgery, diagnosis and treatment

are possible effective surgical.

The Cardiac tumors (CT) are divided into primary

and secondary or metastatic; the latter are about 20-40

times more frequent than the primary ones. Primitive

CT scans are an entity of relatively rare presentation in

medical practice. In a classic Autopsy review of Straus

and Merliss [1], its incidence was 0, 0017-0, and 28%.

Lymbjmnurner [2] found only 4 cases in 8,500 autopsies,

which offers an incidence of 0.05%. Nadas and Ellison [3]

found 1 case for every 10,000 autopsies. These references

are old, and although we start from the fact that primitive

TC are rare, each time more and more publications appear

in this regard, and in this sense should be made the

following considerations: It is an uncommon disease not

exceptional as it was a few decades ago; more and more

cases have been diagnosed and this has contributed to the

use and application of echocardiography as a fundamental

diagnostic tool in cardiology; In Medical-surgical units of

cardiology accumulate a variable number of cases over the

years, and the individual experience of a cardiologist or

surgeon may be limited. Approximately 75% are benign

and of these, more than 50% of the cases are Myxomas,

25% are malignant and most of them correspond to

sarcomas. The most frequent benign cardiac tumor in the

adult is myxoma and in the pediatric Age, the Rabdomyoma

followed by Myxoma and Fibroma. The first successful

resection of a benign TC (myxoma) with extracorporeal

circulation (CEC) was performed by Crawford [4] in

1954. Several articles, especially short-series or isolated

cases have been published later; a considerable number of

clinical, surgical and pathological reviews have also been

carried out, part of which is the basis of our presentation of

a case [5-13].

Summary

This is the patient Y.M.R. 51 years of age; Male;

White, long-date smoker; Drinker; University; That with

manifestations of heart failure with heart rhythm disorders;

Cerebral micro embolisms with repeated and prolonged

clinic tonic convulsions; Hemoptysis; Psychiatric

*Corresponding author: Rodolfo Vega Candelario, Assistant professor of

Medical Sciences, Ciego de ávila University.Head of Cardiology services

at Roberto Rodríguez, Moron Hospital; Ciego de ávila, Cuba. E-mail:

[email protected]; Tel: +5354042388

Received January 25, 2018; Accepted June 13, 2018; Published June 27,

2018

Citation: Rodolfo Vega Candelario (2018) Echocardiography Study and

Variability of Symptoms of the Cardiac Myxoma Concerning Three Cases

in a Period of Six Months. SF J Cardiol 2:1.

Copyright: ? 2018 Rodolfo Vega Candelario. This is an open-access

article distributed under the terms of the Creative Commons Attribution

License, which permits unrestricted use, distribution, and reproduction in

any medium, provided the original author and source are credited.

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Citation: Rodolfo Vega Candelario (2018) Echocardiography Study and Variability of Symptoms of the Cardiac Myxoma Concerning Three Cases in a

Period of Six Months. SF J Cardiol 2:1.

disorders; General syndrome with Asthenia; Anorexia;

Weight loss; He visited several institutions being studied

by multiple specialties with multiple studies for two years.

Several treatments with negative results were indicated, he

has being examined meticulously by the cardiology service

specialists of the Hospital in Moron City, finding during

the physical examination a diastolic drag with diastolic

stroke at the level of the mitral focus In an emergency

case and he got a Color Doppler echocardiogram where he

was able to diagnose cardiac myxoma after that, we made

a fast coordination to transfer the patient to the Cardio

center in Santa Clara City where he had the corresponding

preoperative tests including hemodynamic studies and

Respiratory functional tests. After excision of the open

heart Tumor with extracorporeal circulation; Histological

studies were done proving that it was a myxoma; Then it

has been followed by consultation with tax examination;

Echocardiography; Electrocardiography; X; Ergometer.

The patient evolves very well with excellent quality of life

[14-19].

Presentation of our Patient

Patient J. M.R. of 51 years of age; white male;

Smoker from childhood; Habitual drinker; College-level;

It began two years before the diagnosis with dyspnea of

exertion; Pressure dyspnea that did not allow sleeping in

bed; He had to make him sit down and so he suffered a lack

of air and what was most alarming was the expulsion of

blood; Repeatedly through the mouth, red, glittering, which

we consider as hemoptysis by pulmonary hypertension by

the occupation of myxoma space and intermittent Mitral

stenosis causing the same; Irregular rapid palpitations that

indicated that his cause was atrial fibrillation with rapid

ventricular response, had repeated falls to the ground

with total loss of knowledge, lasting 30 to 35 minutes

accompanied by tonic convulsions Generalized cloning;

According to their relatives, the patient does not remember

anything about what happened, says that he suffered blows

in several parts of his body then was very decayed and his

recovery was very slow both physical and mental; This is

interpreted as possible micro embolisms repeated from the

Tumor “ benign “ that is very friable and embolism; This

pain was repetitive and became discomfort to the patient

and his family, was very difficult because for two years

had no precise diagnosis and after multiple treatments

for different specialties, annoying studies and other less

annoying in which always were absent the Color Doppler

echocardiogram or other similar research such as cardiac

Nuclear magnetic resonance and it was because never one

suspected cardiac Myxoma or any other type of Tumor

of the organ as indicated by the narrated and the patient.

It was so much its decay that it was too exhausted to sit

alone but it points out “ could not lie down and this made

him weaker and sadder to fall into a “Great Depression“,

asthenia, anorexia and weight loss were evident losing in

the two years of Evolution 20 kilograms. The disorders

of his psiquis led him to abandon hygienic habits and

repeated crying.

At this time it was studied by clinicians,

neurologists, pulmologists, cardiologists, psychiatrists,

radiologists; Surgeons; Immunologists; making multiple

hematological, immunological, radiological research

including simple tomography, ultrasound, blood cultures,

urine, fecal feces; Esophageal endoscopy; Stomach and

duodenum, colonoscopy; Mental tests within psychiatry;

Electroencephalograms; All this illness put him weaker

every day until when he could not perform his activities of

daily life.

Upon physical examination in the afternoon of May

25, 2017, the heart sound evidenced a long diastolic drag

with a diastolic stroke (Plop diastolic) that led us to perform

an emergency echocardiographic study to show images to

be compatible with Myxoma pedunculated left atrium that

causes intermittent mitral stenosis; Pre-operative studies

were carried out and coordinated urgently with Santa Clara

Center where he was tested normal respiratory functions

and also study hemodynamic with ventriculography left

with angiography where it was found that they had not

Coronary lesions and that the echocardiographic diagnosis

of Myxoma was corroborated; A confirmatory histological

study of the tumor was done after the tumor was removed.

The patient was followed by us with echocardiography,

radiological studies; Electrocardiographic; Ergo

Metric Test In addition to physical examination and is

asymptomatic with functional capacity grade I (according

to NYHA) [20].

Images of the Patient’s Transthoracic

Echocardiogram

Conclusion

Cardiac myxoma is the most common benign

tumor in the heart and its symptomatic variability can

lead to diagnostic confusions to the most seasoned of our

physicians.

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Citation: Rodolfo Vega Candelario (2018) Echocardiography Study and Variability of Symptoms of the Cardiac Myxoma Concerning Three Cases in a

Period of Six Months. SF J Cardiol 2:1.

Figure 1: Adult Echocardiogram Pediculated Myxoma of the Left Atrium Causes Intermittent Mitral Stenosis. Echocardiogram

Doppler: Mitral Stenosis Adult Echocardiogram

Figure 3: Anatomical Image of the Myxoma (A) and Histological (B) of the Myxoma-Patient Y.M.R

Figure 2: Transtoracic (TTE): In These Echocardiographic Images it is shown that when the Tumor or Myxoma (M) is Introduced

into the Mitral Valve Hole it Causes a Blockage of the Valve Causing a Major Defect of the Left Ventricle and a Backwater of Blood

in the Left Atrium Behaving as a Severe Intermittent Mitral Stenosis

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SF J Cardiol Volume 2 · Issue 1 · 1000014

Citation: Rodolfo Vega Candelario (2018) Echocardiography Study and Variability of Symptoms of the Cardiac Myxoma Concerning Three Cases in a

Period of Six Months. SF J Cardiol 2:1.

It is a benign Tumor (myxoma) is easy to diagnose

and surgical treatment if we have it present at every

moment of daily medical practice; Especially when there

is confusion diagnosed by the variability of his symptoms

present in the patient.

Any patient presented with symptomatic variability

chart should be Doppler echocardiogram among the other

studies that are practiced.

Although the cardiac myxoma has

histopathological characteristic of “Tumor benign” we

consider that its behavior is malignant with very varied

polymorphous symptomatology that occurs in any organ

or system and that can bring confusion diagnose as in the

Case we expose.

References

1. Robert OB, Douglas LM, Douglas PZ, et al. (2013) Cardiology

Treaty: Text of cardiovascular medicine. 9th Edition Primary

cardiac tumors. Bruce McManus 1660-1670.

2. Ciril Rozman B, Farreras-Rozman (2012) Medicina Interna

Metabolismo y nutrición. Endocrinología17th Edition 304.

3.Hernández BO, Ortiz HC (2013) Histopathological and

immunohistochemistry characteristics of cardiac myxomas.

NCBI 83: 199-208.

4. Rottier SR, Vega UGA (2012) The most common primary

heart Tumor: Cardiac myxoma. Medical Journal from Costa

Rica and Central America 69: 604.

5. Mu?oz SD, García E, Páez J, et al. (2013) Myxoma giant right

atrium. Presentation of a case. Cir Cardiov 20: 203-205.

6. Dan LL, Anthony SF, Dennis LK, et al. (2013) Harrison

principles of Internal Medicine, 18th edition. Chapter 240 Tumors

and cardiac injuries. McGraw-Hill inter-American.

7. Manzur JF, Barbosa Cristian, Puello Agustín (2011) Left atrial

myxoma associated with severe mitral valve insufficiency in a

31-year-old female patient: case report. Rev Colomb Cardiol 18:

345-349.

8. Laso Guzmán, Javier F (2013) Differential diagnosis in

Internal Medicine, third edition. Section V: Circulatory system.

Chapter 23: Radiological Cardiomegaly 147.

9.Navarro OD, Fernandez LJ (2016) Mitral stenosis by left atrial

myxoma. Colombian Journal of Cardiology 23.

10. Moreno AM, Ortiz SV, Deudero IA, et al. (2016) A classic

systemic vasculitis simulator. Rheumatology Clinic 12: 103-106.

11. Vico Kiss L, Zu?iga CE (2013) Pulmonary thromboembolism

secondary to right atrium myxoma. Mergen 9: 54-56.

12. Failo M (2011) Stroke and atrial myxoma. CONAREC

Magazine 27.

13. Sabater N, Saddlebag S, King A, et al. (2013) Late diagnosis

of ophthalmic artery obstruction by atrial myxoma. Archives of

the Spanish Society of Ophthalmology 88: 313-315.

Second Patient

Title: Cerebral Cardio Embolic Disease; Ischemic

Stroke (ACV) Cardio Embolic to Starting Point in

Myxoma of Left Cavities: Large; Highly Mobile

and Very Friable; No Calcification What So Ever

Keywords

Myxoma; Cardio Embolic Phenomenon; Cerebral

Infarction

Introduction

Cardiac tumors are a rare pathology. They are

classified in primary or secondary as they originate in

the heart or are metastases from extra-cardiac tumors.

Of the primary tumors, 75% are benign and, of these,

more than half corresponds to Myxomas. They may be

asymptomatic or generate cardiac, systemic or embolic

manifestations. Tumors located in left cavities can cause

systemic embolisms, with the brain being the most

affected organ. The most common clinical manifestation

ITA. In many cases, convulsions and ocular manifestations

may occur. Cardiac images allow for a proper diagnostic

approximation, although the definitive diagnosis is only

obtained with the histopathology of the tumor tissue.

The best alternative for benign tumors is usually surgical

treatment, which in many cases can be considered curative

[1].

They are characterized by being soft, gelatinous

and very friable, which favors the detachment of emboli’s

fragments. 1 The mean age at the time of diagnosis is 50

years (90% between 30-60 years), with greater prevalence

among women. They may be asymptomatic for prolonged

periods. Clinically can be presented with the described

Good wing Triad, which consists of general manifestations

(90%), due to the secretory activity or tumor necrosis,

such as prolonged fever, weight loss, anemia, leukocytosis

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Citation: Rodolfo Vega Candelario (2018) Echocardiography Study and Variability of Symptoms of the Cardiac Myxoma Concerning Three Cases in a

Period of Six Months. SF J Cardiol 2:1.

and rate High; Embolic manifestations (3 to 40%), by

detachment of the myxoid material to the systemic or

pulmonary circulation; and obstructive manifestations,

by commitment of various cardiac structures. Other less

frequent forms of presentation are sudden death (15%)

and tumor infection. 1 in 5 to 10% of cases the family

form is presented, which is transmitted with an autosomal

dominant character (and occurs preferably in males under

20 years old, with less Predilection for the left atrium

and with multiple tumors masses). It is known as Carney

complex (Myxomatoso syndrome) to the Association of

Myxomas, hyper pigmented spots on the skin (especially

nevi or diffuse lentiginosis) and endocrine hyperactivity

(Cushing syndrome, Fibro adenomas mammary, testicular

tumors and pituitary adenomas. [2] The use of different

imaging methods isEssential to reach an adequate

diagnostic approach (ETT, ETE, TC and/or RM), with

echocardiography as the main diagnostic method (many

tumors are a imagines finding in asymptomatic patients).

Differential diagnoses include vegetation, cavitation,

malignant tumors, and wall tumors [1]. The definitive

diagnosis of myxoma depends on the pathological

anatomy along with the immunohistochemistry of the part.

Once the tumor diagnosis is myxoma compatible, surgical

resection should be done as soon as possible due to the

possibility of sudden death and Embolic events. [3] The

prognosis is excellent after the lumpectomy. Recurrences

are uncommon (5 to 15%) and usually develop between

6 months and 4 years after resection [4]. These are more

common when the resection was incomplete or inadequate,

with the multi-centric origin not recognized at the time of

surgery (false recurrence), when implanted outside the

atrial septum, and if they occur associated with genetic

syndromes (complex of Carney) [5].

The patient’s clinical picture and the complementary

tests performed were compatible with ischemic stroke of

cardio embolic origin, considering as the most probable

diagnosis to the atrial myxoma. Within the cardio embolic

causes (13% of total ischemic strokes), you should always

consider the possibility of myxoma considering that this

is the most common primary heart tumor [6] Systemic

embolism. Embolism occurs in 30% to 40% of the cases7.

More than half of the Myxomatosos emboli migrate to

the central nervous system [5, 7], but any arterial system

can be affected and produce a wide variety of signs and

symptoms. Case reports document embolism in upper and

lower extremities, coronary arteries, kidney, liver, eyes,

skin and spleen [7]. Risk factors for embolization include:

large tumor size, increased mobility and polyposis nature,

location in the mitral valve and left ventricle, and absence

of calcifications [8].

Summary

This is the patient of 53 years old; Male; Black,

long-date smoker; Drinker; hypertensive; He suffered

from dizziness; Headache; General malaise; Decay; Joint

pains Palpitations; Dyspnea; Orthopnea; about more than a

year [9-14]. He then suffered a loss of consciousness with

lost muscular strength of the left hemi body; Interpreted

as an accident-Vascular brain (ACV) type Embolic. It was

admitted and was fulfilled bio psychosocial rehabilitation

by multidisciplinary team. After 6 months he continues

with important and troubling symptoms for him and his

family as palpitations; Dyspnea; Orthopnea; Angor type

pain; Marked decay; It remained squatting by decay and

discomforts articular and osseous; That attributed to his

hypertension; To smoking and drinking habits [15-18].

I visit the cardiology clinic at our hospital; with your

family member; Being thoroughly examined by the head

of the cardiology department of that institution, finding

the physical examination a diastolic stroke with diastolic

strike (plop) at the level of the mitral valve, which led him

to carry out an emergency Color Doppler echocardiogram

where he was able to diagnose cardiac myxoma and urgent

coordination his transfer to the heart of Santa Clara where

he had the corresponding preoperative tests including

hemodynamic studies and functional respiratory tests

[19-21]. After excision of the open heart Tumor with

extracorporeal circulation; Histological studies were

done proving that it was a myxoma; Then it has been

followed by physical examination; Echocardiography;

Electrocardiography; X; Ergometer. The patient evolves

very well with excellent quality of life and a functional.

53 year old patient-smoker-drinker’s patient:

Cerebral heart attack, 6 months before the diagnosis of

heart myxoma (Diagnostic of myxoma-12-08-2017). It

shows a friable contexture that favors embolismCerebral

heart attack for phenomenoncardioembólico (heart

Myxoma: big; with great mobility; friable and without

calcifications). (LEFT HEART CAVITIES). Patient

O.Q.M.

Patient O.Q.M. -53year Old; Drinker, Operated

De Heart Myxoma Emboligeno (Cerebral Heart

Attack) Operated the 12-08-2017

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Citation: Rodolfo Vega Candelario (2018) Echocardiography Study and Variability of Symptoms of the Cardiac Myxoma Concerning Three Cases in a

Period of Six Months. SF J Cardiol 2:1.

Patient; Operated the 12-08-201

Our Patient’s Discussion

Patient O.Q. M 53 years old; Male; Black;

inveterate smoker; Habitual and hypertensive drinker with

non-adherence to his diet and antihypertensive drugs. He

was suffering from headache; Dizziness; Palpitations;

Chest pain, anginal type; falls to the ground; General decay

and malaise that did not allow him to fulfill activities that he

previously performed with ease. Then he suffered a sudden

loss of consciousness; Seizures; Long-term; Regaining

consciousness found difficulties in the articulation of

language; Severe headache and it was impossible to

walk properly by loss of motility of the left hemi body;

He had breathless palpitations and chest pain angor type.

CT was performed confirming the diagnosis of cerebral

infarction of the right cerebral hemisphere and was entered

with timely treatment and early rehabilitation; According

to Protocol established. Everything was attributed to his

hypertension badly controlled; to their habit of eating

frequent alcoholic beverages and smoking. After 6 months

of his comprehensive rehabilitation treatment, he still

feels a great general malaise; Decay; Joint pains; Fever;

Headache; Chest pain, Angor type; Dyspnea to exertion

and orthopnea; Palpitations and ¨ dizziness as if you were

going to die ¨ goes to cardiology consultation to control

your blood pressure and know the causes of the other

symptoms. When examining it the cardiologist found

it long diastolic murmur and diastolic plop; I performed

emergency Color Doppler echocardiogram and found

that in addition to moderate concentric hypertrophy and

its discrete diastolic dysfunction presented a large cardiac

myxoma that scales from the left atrium (LA) to the left

ventricle (LV) With great mobility with a long pedicle

which allowed him to spend more time in left ventricle

than in the left atrium; With a Friable aspect and that

although the Mitral valve remained healthy caused him to

interlock in the valve orifice making it difficult to pass the

blood in diastole of the left atrium (LA) to the left ventricle

(LV). He immediately contacted the head of cardiovascular

Surgery of the Santa Clara Cardiac Center; Making an

urgent transfer to the center where it was performed.

Hemodynamic studies with emergency

angiography that confirmed the presence of the Tumor with

normal coronary artery and without Mitral valve injury. We

performed respiratory functional tests and hematological

check essential for after the results proceed to surgery with

extracorporeal circulation to open heart and perform the

removal of the large Tumor; Taking the piece to anatomy

pathology for his study Anatomichistological and verify

that it was a benign Tumor histologically very Friable.

Myxoma with long pedicle allowing it to remain in the

left ventricle and locked in Mitral valve orifice. After this

intervention the patient has evolved excellent therapeutic

prescript for his moderate hypertension; abandoning their

toxic habits of cigar and alcohol and with very good quality

of life. We followed him for cardiology consultation with

chest X-ray; Color Doppler echocardiography; EKG;

Thorough physical examination and ergo metric test. In

the short time of evolution has remained asymptomatic

and with an excellent functional capacity.

Conclusion

Intracavitary heart tumors occupy a special place

in cardiac surgery due to their unique characteristics.

Some of them are considered surgical emergencies.

Resection should not be delayed since 8-10% of affected

patients may die pending operation due to intracardiac

blockage of blood flow. In daily practice, patients with

cardiac tumors that are operated are not frequent, only

a few hours after the diagnostic confirmation through

ultrasound studies,the case of a patient with the diagnosis

of pedunculated left atrial myxoma, large, with incursion

into the left ventricle during diastole, which was surgically

intervened, due to the probabilities of fragmentation and

embolization by the morphological characteristics of the

tumor and had already undergone a stroke cardio embolic

with Cerebral infarction and sequelae that led him to 6

Figure 1: A: RNM Que Muestra Infarto Isquemico En Territorio

Silviano De La Arteria Cerebral Media Izquierda(Circulo

Punteado). B:Plano Apical Cautro Camaras En Diastole Con

El Mixoma Prolapsando En Ventriculo Izquiredo(AI: Auricula

Izquierda. AD: Auricula Derecha. VI: Ventriculo Izquierdo, VD:

Ventriculo Derecho, Mx: Mixoma Auricular Izquierdo)

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Citation: Rodolfo Vega Candelario (2018) Echocardiography Study and Variability of Symptoms of the Cardiac Myxoma Concerning Three Cases in a

Period of Six Months. SF J Cardiol 2:1.

months of rehabilitation in our institution as a sequel to

the physical limitation and Motor of the left hemi body

(left hemiparesis by ischemic infarction by the cardio

embolic phenomenon which suffered and even after a

programmed rehabilitation and well accomplished by

multidisciplinary team (physiatrist; speech; Occupational

therapy; Neurologists; Physiotherapists).

References

1. Galucci E (2010) Tumors and cardiac cysts. In: Mautner M.

Cardiology based on the evidence and experience of the Favaloro

Foundation. 2nd Edition Buenos Aires. Editorial Mediterranean

1387-1407.

2. Butany J, Nair V, Nassemunddin A, et al. (2005) Cardiac

tumours: Diagnosis and management. Lancet Oncol 6: 219-228.

3. Vargas BJ, Vargas AG, Roldán FJ, et al. (2008) Cardiac

myxomas and Carney complex. Magazine ESP Cardiol 61:

1205-1209.

4. Suárez L, Cianciulli T (2000) Cardiac tumor. In: Bertolasi

C, Barrero C, Gimeno G, Liniado G, Mauro V. Cardiology 1st

Edition Buenos Aires. Editorial Medical Pan-American SA

790-820.

5. Geoff King D (2008) Stroke. Lancet 371: 1612-1623.

6. Schaff HV, Mullany CJ (2000) Surgery for cardiac myxomas.

Semin Thorax Cardiovascular Surgery APR 12: 77-88.

7. Castells E, Ferran V, Octavio de Toledo MC, et al. (2000)

Surgery for cardiac myxomas. Semin thoracic CARDIOVASC

Surg 200.

8. (2013) Rev FAC 100 Med Nat. University, Cordoba 70: 91-93.

9. Eugene Braun Wald (2013) Cardiology Treaty: Text of

cardiovascular medicine. 9th Edition Robert O Bonow, Douglas

L Mann, Douglas P Zipes, Peter Libby. Primary cardiac tumors.

Bruce McManus 1660-1670.

10. Ciril Rozman B, Farreras-Rozman (2012) MedicinaInterna

Metabolismo y nutrición. Endocrinología 17th Edition 304.

11. Hernández BO, Ortiz HC (2013) Histopathological and

immune histo chemistry characteristics of cardiac myxomas.

Arch Cardiol Méx 83: 199-208.

12. Rottier SR, Vega Ulate GA (2012) The most common

primary heart Tumor: Cardiac myxoma. Medical Journal from

Costa Rica and Central America 69: 604.

13. Mu?oz SD, García E, Páez J, et al. (2013) Myxoma giant

right atrium. Presentation of a case. Cir Cardiov 20: 203-205.

14. Dan LL, Anthony SF, Dennis LK, et al. (2013) Harrison

principles of Internal Medicine, 18th edition. Chapter 240 Tumors

and cardiac injuries. McGraw-Hill inter-American.

15. Manzur JF, Barbosa Cristian, Puello Agustín (2011) Left

atrial myxoma associated with severe mitral valve insufficiency

in a 31-year-old female patient: case report. Rev Colomb Cardiol

18: 345-349.

16. Laso Guzmán, Javier F (2013) Differential diagnosis in

Internal Medicine, third edition. Section V: Circulatory system.

Radiological Cardiomegaly 147.

17. Navarro OD, Fernandez LJ (2016) Mitral stenosis by left

atrial myxoma. Colombian Journal of Cardiology 23.

18. Moreno Ari?o M, Ortiz Santamaria V, Deudero Infante A, et

al. (2016) A classic systemic vasculitis simulator. Rheumatology

Clinic 12: 103-106.

19. Vico BL, Zu?iga CE (2013) Pulmonary thromboembolism

secondary to right atrium myxoma. Mergen 9: 54-56.

20. Failo M (2011) Stroke and atrial myxoma. CONAREC

Magazine 27.

21. Sabater N, Saddlebag S, King A, et al. (2013) Late diagnosis

of ophthalmic artery obstruction by atrial myxoma. Archives of

the Ophthalmology Spanish Society from 88: 313-315.

Third Patient

Title: Several Diagnoses for the Same Cardiac

Myxoma; 6 Years of Evolution. About A Case

Keywords

A Myxoma; Several Diagnoses

Overview

Primary heart tumors are rare diseases in all age

groups, representing 0.2% of total human neoplasms.

Cardiac Myxomas have an annual incidence of 0.5 per

million people. The case of a 60-year-old patient with

personal pathological antecedents of ischemic heart

disease and heart failure has been diagnosed for two

years, a period from which he has repeated episodes of

sensation of palpitations, ángor Pectoris and sudden

dyspnea especially when rejoining the bed; Reasons

why it was valued by internal medicine and cardiology.

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Citation: Rodolfo Vega Candelario (2018) Echocardiography Study and Variability of Symptoms of the Cardiac Myxoma Concerning Three Cases in a

Period of Six Months. SF J Cardiol 2:1.

Through color Doppler echocardiography a pedunculated

left atrial myxoma is diagnosed as a cause of intermittent

mitral stenosis, heart rhythm disorders (atrial fibrillation

blocked) and episodes of acute coronary syndrome. The

patient was immediately referred to the Cardiovascular

Surgery service for surgical intervention.

Patients with cardiac myxomas Symptoms

clinically present a wide variety of nonspecific symptoms

that depend on the size, location, and mobility of the

tumor. Both the diagnosis of cardiac myxoma and the rest

of cardiac tumors, represent a medical challenge, due to

the different forms of clinical presentation that explain the

delay in the diagnosis. They can have catastrophic effects

from the deterioration of the structure and cardiac function.

So the key to early diagnosis of a cardiac tumor is always

to consider them as a differential diagnosis.

Taking into account the interesting thing from

the medical-scientific point of view, it was mapped as

objective of this investigation: to describe the clinical case

of a patient carrying a myxoma left atrial pedunculated as

a cause of intermittent mitral stenosis.

Presentation of the Clinical Case

Reason for consultation: “Lack of air; Chest

pain; Skin lesions; Double vision; Severe leg pains;

Joint inflammation with arthralgia and fever; Loss of

consciousness and convulsions.”

History of the Current Disease

A 60-year-old male patient with white skin color

and personal pathological history of ischemic heart disease

and heart failure diagnosed since 2014; For what it takes

treatment with nitropental (10 mg) 3 tablets three times

daily, spironolactone (25 mg) 1 tablet every 12 hours,

aspirin (125 mg) 1 tablet per day and Carvedilol (12.5 mg)

6.25 mg every 12 hours. Coinciding with the diagnostic

data, the patient has presented repeated episodes of

intense paroxysmal dyspnea that have as a cardinal

semiology element that are exacerbated when moved

from the position of Decubitus has sat accompanied by

continued coughing and Intense. In addition, it refers to

“palpitations” that when they are very intense: irregularly

irregular: Itdescribes pictures of feeling that as “will lose

the knowledge” (interpreted like pre-cups) other times it

makes pictures of total loss of knowledge: with Generalized

seizures: stertorous respiration presided over the preceding

table (we interpreted it as a cardiac syncope in the form of

a stock Crisis Adams and many times a breath of Scheringstock

was raised) that we considered as possible stroke a

Repeated cerebral micro-embolisms; The neurologist

interpreted it as epilepsy and indicated phenytoin-refers to

“pain in the center of the chest” that radiates to the left arm

appearing more frequent at rest and many times; With the

same characteristics; to physical exertion; It has had up to

3 sublingual nitroglycerines to achieve relief; This picture

has become more frequent; Long-lasting and intense in

the course of time (this has been interpreted as an acute

coronary syndrome; SCA; What has caused you income in

more than 10 occasions; As the patient and family members

point out. During this period (last 3 years) of time the

patient presented five hospital admissions in addition to

repeated visits to the emergency service of the institution

where he has been treated with the clinical tables described.

The patient ended up in the Hospital in bed 4 of the internal

Medicine room of our center with Anasarca; Vascular and

dermatological lesions that were interpreted as vacuities;

Skin coloring changes of inferior limbs; 38-degree fever;

Inflammation in multiple joints that did not allow him to

wander; Very intense intermittent pains in lower and upper

limbs; Vision difficulty; Blurred vision and diplopia at this

time clinicians posed a possible mixed collagen disease

but the complementary ones performed showed absolutely

normal results despite the severity chart. dyspnea; The

Orthopnea; The cough and the clinical picture described

madehim complain constantly, with a lament; Repetitive;

of death; After realizing the patient and his severity; We

decided to do questioning and physical examination;

electrocardiogram; EKG and later Echocardiogram Color

Doppler that surprised us with the images we pointed out

and placed in our modest presentation of this case.

Based on the polymorphism of symptoms

described above and varied diagnoses made, it is decided

to focus this patient as a very critical sick and despite the

chances of death he had also existed the possibility of

saving his life with a Quick and accurately diagnosed care.

So things and without wasting time was achieved a timely

transfer thanks to the help of the cardiovascular Surgery

head from cardio center in Santa Clara that gave us all the

necessary support. In the face of such a deteriorated but

possibly lifesaving patient, he did what is appropriate. We

achieved a dynamic internship behavior; Cardiologist and

cardiovascular surgeon as it pertains to a case of myxoma

with a diagnosis.

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Citation: Rodolfo Vega Candelario (2018) Echocardiography Study and Variability of Symptoms of the Cardiac Myxoma Concerning Three Cases in a

Period of Six Months. SF J Cardiol 2:1.

Physical Exam

Mucous membranes: humid and norm coloured.

Cutaneous cell tissue: Anasarca-shaped edema.Vasculitis.

38.5 degrees Celsius fever; Poly-articular inflammation;

severe functional limitation.

Difficulty of vision and mental state of

uncontrollable anxiety and nervousness but with an aspect

of exhaustion and frustration interpreted as a situational

depressive episode by Psychiatry.

Respiratory system: Audible and normal vesicular

murmur, do not listen to wet or dry rales. Respiratory rate:

19 breaths per minute(Usually).

When it does picture of acute lung Edema appears

dyspnea; Polypnea; Rales crackles in montane tide

associated with the other symptoms of this entity.

ACV: Cardiac Arrhythmic noises , first strong

variable noise in the form of “strong stroke”, is heard

murmur diastolic intensity II/VI long and intermittent

pulse that changes intensity; length and tone; With the

difference in the position of the patient and the time of

auscultation.

Heart rate: 61 beat per minute. Blood pressure:

120/70 millimeters of Mercury.

At the time of the Pre-trial or the heart rate:

arterial pulses in addition to arrhythmic decreases in

intensity and amplitude to become filiform and virtually

imperceptible. It appears pallor and discrete acrocyanosis;

Pupillary dilation. The acceleration of the heart rate gives

rise to a very alarming Taquiarrtmia (despite the use of

Beta blockers; b/b; Administered to the patient). There is

thermal gradient and profuse sweating.

It appears congestion of the jugular veins and in the

jugular pulse with disappearance of the wave A. Instead,

a reflux appears in diastole reminiscent of a cannon wave

in the jugular venous pulse; that we explained by the

Transient pulmonary hypertension (HTP) that appears in

the patient to lock the myxoma pedunculated in the orifice

of the Mitral valve obstructing and creating a retrograde

blood control. HTP can also be seenwhen a myxoma with a

pedicle so long scales and is directed to the pulmonary veins

and occludes the fours or less (total or partial) giving acute

Edema of both lungs and in case of partial obstruction can

give; Exceptionally; Acute single-lung Edema (obstruction

of the 2 pulmonary veins corresponding to either lung; this

is practically pathognomonic of the myxoma with long

left atrium pedicle; AI) and our patient suffered it; Making

acute Edema of the lung of only the left lung; What was

inexplicable to the Emergence doctors who attended him

at that time.

Digestive System: No alterations.

Central nervous system: patient, although

conscious and oriented he was very anxious and concerned

about his health.

Complementary Exams

Blood count: 13 grams per liter.

Leucogram: 12 x 109/L.

Rate: 10 mm/h

Transaminases: TGO: 40 u/L, TGP: 36 u/L, GGT: 39 u/L.

Alkaline phosphatase: 180

Azoados: creatinine: 85 Micro moles/L, Urea: 5, uric acid:

349 micro moles/L.

Lipid: triacilglycerides: 1.9 mmol/L, Cholesterol: 6.2

mmol/L

Fasting glycemic: 6.2 mmol/L.

Cardiac biomarkers: no alteration.

VDRL serology: Negative.

HIV: Negative.

Surface antigen: doubtful (repeats; negative).

Hepatitis B antigen: Negative

EKG: Rhythm of atrial fibrillation with adequate

Ventricular response (effect of B/b drugs indicated?).

Shows ST-T disorders that can be considered as nonspecific

disorders of left Ventricular repolarization by

effect of myxoma on hemodynamic and cardiac cycle and

alterations of secondary coronary flow to these affectations

(more Visible from V1 to V6). Signs of right branch block

of the Hiss Purkinje ha are associated(RSR ′ from V1 to

V4) (All constitutes a right branch block with associated

atrial fibrillation and signs of myocardial ischemia) (Figure

1)

Our patient had multiple diagnoses before reaching

myxoma; Among them: heart failure due to systolic

dysfunction which was ruled out by the Doppler Echo and

the hemodynamic study that were done pre surgically; Also

discarding the possible coronary obstruction and ischemic

heart disease and of course the acute coronary syndrome

(SCASEST) due to coronary lesions. Due to the functional

ventilatory and respiratory tests, the respiratory cause was

ruled out (COPD raised).

Takayasu’s disease was ruled out when it was

demonstrated that vacuities was by cardiac myxoma.

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SF J Cardiol Volume 2 · Issue 1 · 1000014

Citation: Rodolfo Vega Candelario (2018) Echocardiography Study and Variability of Symptoms of the Cardiac Myxoma Concerning Three Cases in a

Period of Six Months. SF J Cardiol 2:1.

Figure1: These Ultrasound Images Show that the Insertion of the Tumor or Myxoma (M) in the Mitral Valve Hole Causes a

Blockage of the Valve Causing an Important Filling Defect of the Left Ventricle and a Blood Pool in the Atrium Left Behaving as

a Severe Intermittent Mitral Stenosis

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SF J Cardiol Volume 2 · Issue 1 · 1000014

Citation: Rodolfo Vega Candelario (2018) Echocardiography Study and Variability of Symptoms of the Cardiac Myxoma Concerning Three Cases in a

Period of Six Months. SF J Cardiol 2:1.

Rheumatic poly articular disease was raised as

well as mixed connective tissue disease; that were ruled

out by the totally normal hematological study.

The primary ophthalmological disease was

ruled out by finding a fund of eye with unclear vascular

alterations and the ophthalmological examination raises

the possible secondary cause embolic.

Epilepsy was not ruled out until the diagnosis of

myxoma and the approach of recurrent stroke by micro

cerebral embolisms. The Anasarca of another cause was

ruled out by the hematological study of hepatic and renal

function; Total proteins and other blood research. His

psychiatric behavior was due to his poor general condition

and his great discomfort secondary to the polymorphism

of symptoms and worsening of his clinical picture.

Already diagnosed cardiac myxoma; removal; His

histological study and anatomical appearance along with

the clinical evolution of the patient; It is shown that of all the

diagnoses posed the only one that was definitive was that

of cardiac myxoma with a great variability symptomatic

that led to the path of erroneous diagnoses but with the

satisfaction that all occurred premorten and the patient that

to the passage of almost A year has completely changed his

appearance of sick and enjoys full health and useful from

the point of view bio psychosocial and family. (Figure 2)

Discussion

Cardiac tumors can be asymptomatic or cause

diverse and varied symptomatology, so they have been

called the “great simulator”. From the clinical point of

view, patients with symptomatic cardiac myxoma may

have various nonspecific findings that often create much

confusion and make it difficult to diagnose, simulating

from an immune disease or presenting with any Cardiac

symptom [1-3].

More than 50% of the patients present a clinical

picture that simulates a mitral stenosis, and in more than

30% of the patients the Myxoma gives rise to tumoral

embolisms. However, most patients will consult with at

least one of the elements of the classic triad of cardiac,

embolic and constitutional or systemic obstructive signs

[1, 2, 4].

Obstructive cardiac findings are due to

mechanical interference of the tumor with the mitral

valve and are the most frequent initial triad findings.

Left atrium Myxomasmay cause heart failure due to the

occupation of the tumor mass or the phenomenon of

tumor interlocking in the mitral valve which may cause

dizziness, paroxysmaldyspnea, cough, pulmonary edema,

syncopeor sudden death. In addition, they can embolize

to the coronary arteries, cerebral vessels, renal, aortic

bifurcation, or arteries of the lower extremities [1, 4].

In patients with myxoma in the left atrium,

Auscultation reveals an intense S1 and an accentuated S2,

followed by an early diastolic tone. This noise, the “Plof

tumor”, is produced by the prolapse of the tumor through

the mitral valve [2, 4].

The left atrial myxoma should also be considered

in all patients in whom mitral stenosis is suspected if there

is no history of rheumatic fever or heart murmur, or if

the murmur occurs intermittently or is perceived only in

certain positions, and If there are associated embolisms in

patients in sinus rhythm [4].

Manzur [5] Reports the case of a 31-year-old

patient with a left atrial myxoma associated with symptoms

of severe mitral valve failure.

Moreno Ari?ob [6] describes a case of atrial

myxoma with presentation in the form of systemic

vasculitis. Other forms of presentation such as pulmonary

embolism thrombus [7], Cardio embolic Stroke [8], and

ophthalmic artery obstruction [9] have been described. It

is valid to clarify that the Embolic events are secondary

to myxoma of right cavities, but partly corresponds to our

case despite being a myxoma of left cavities.

Antolín [10] shows a patient with an atrial

myxoma, which caused acute renal failure by

rhabdomyolysis secondary to ischemia of its inferior limbs

after embolization of a tumor fragment.

Al-Fakhouri [11] and Imbalzano [12] present two

cases of patients carrying left auricular myxoma as causes

Figure 2: The Images Show the Dimensions of the Left Atrial

Myxoma 4.4 X 5.7 Cm, Occupying Practically the Entire Atrium

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SF J Cardiol Volume 2 · Issue 1 · 1000014

Citation: Rodolfo Vega Candelario (2018) Echocardiography Study and Variability of Symptoms of the Cardiac Myxoma Concerning Three Cases in a

Period of Six Months. SF J Cardiol 2:1.

of acute coronary syndrome. According to the clinical

characteristics of our case, those described above have

similar elements.

Navarro [13] reports to a 56-year-old man with

no known cardiovascular risk factors or pathological

antecedents, who is diagnosed with a left atrial myxoma

of 4.6 × 4.5 cm. with mitral valve involvement and atrial

fibrillation, coinciding with our study.

According to Bermudez Year [14] sometimes the

left atrial myxoma pedunculated can behave as a surgical

emergency, and according to Garcia Quintana [15] presents

a patient with an infected left atrial myxoma.

Mu?oz Serret [16] and Bermudez Yera R et al.

[17] A 30-year-old male with a giant bilobular right atrium

Myxoma is presented and a 65-year-old patient with a

binaural myxoma, respectively. While Castellanos [18]

shows a left ventricular myxoma in a patient with human

immunodeficiency syndrome. The foregoing does not

coincide with this investigation.

In the present case presentation we can see as

a myxoma left atrial pedunculated moves during the

diastole to the mitral valve causing obstruction to the

atrioventricular flow with episodes of syncope, also

originates a compromise in the ventricular filling causing

symptoms of dyspnea of exertion, orthopnea, paroxysmal

nocturnal dyspnea and acute lung edema. In addition,

we found the interrogation events Angor Pectoris as an

expression of an acute coronary syndrome in the context of

myxoma atrial. The presence of cardiac arrhythmia (atrial

fibrillation) detected through physical examination and

electrocardiogram, are secondary to intra-atrial neoplasia.

The imaging method of choice to perform the

diagnosis is the echo two-dimensional echocardiogram,

which is accurate, reliable; bloodless does not imply any

risk of tumor fragmentation and subsequent embolization.

The sensitivity of transthoracic echocardiography is 93%

and Trans esophageal is more than 97%. In 1959 the first

Echocardiographic diagnosis was performed by Mode M

[1, 4, 16].

The first surgical resection of a left atrial myxoma

was described by Clarence Crafforden 1954, and since then

the obligated surgical nature of this disease was established.

The treatment of choice of myxoma is the early surgical

resection after diagnosis due to the high risk of valvular

obstruction or systemic embolization. It is preferable to

perform extensive resection of the tumor implantation base

to avoid relapses. The long-term prognosis is excellent and

it is recommended to make an annual Echocardiogram [4,

5, 16].

The diagnosis of the patient presented in this report

was performed through Doppler echocardiography. The

patient was referred to the Cardiovascular Surgery service

of the “Ernesto Guevara de la Serna” Cardiac Center in

Villa Clara province for immediate surgical treatment.

As part of the study to the patient, it was decided

to begin to carry out the search in first grade relatives of

possible cardiac myxoma, with the purpose of ruling out a

Carney complex.

The diagnosis of cardiac myxoma is based on

clinical suspicion and is confirmed by Echo Dimensional

echocardiography. This, of course, obliges the medical

group that serves these patients to assume as radical

a behavior as possible during the intervention, and to

maintain an optimal ultrasound follow-up for the rest of

their life.

It is stated that there is no conflict of authors.

Conclusion

Myxomas are the most frequent benign cardiac

primary tumours that exist. Despite its oncological

denomination of benignity, this tumor has a potentially

devastating effect on the patient who presents it.

Depending on its anatomical location, the Mixoma can

produce multiple cardiac symptoms; which can have

deadly consequences. In clinical practice, every physician

should “think” first in a myxoma before patients with

non-specific cardiovascular symptoms. Diagnostic delay

can lead to serious complications. Systematic detection

is necessary in first-degree relatives of patients with

Myxomas. They are tumors that because of their rarity and

forms of presentation pose a challenge for the doctor.

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Citation: Rodolfo Vega Candelario (2018) Echocardiography Study and Variability of Symptoms of the Cardiac Myxoma Concerning Three Cases in a

Period of Six Months. SF J Cardiol 2:1.

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and Variability of Symptoms of the Cardiac Myxoma