Left atrial (LA) myxoma presenting with symptoms of mitral stenosis in elderly males is very rare accounting for 10% of the cases. We report an 80-year-old male who presented with symptoms of orthopnea and palpitations and was subsequently found to have a large LA myxoma obstructing the mitral valve and causing pulmonary hypertension (PHT).

Kounis syndrome is defined as an acute coronary syndrome triggered by the release of inflammatory mediators following an allergic insult characterized by acute onset of breathlessness, palpitations, diaphoresis and chest tightness (Gázquez V, Dalmau G, Gaig P, Gómez C, Navarro S, Mercé J. Kounis syndrome: report of 5 cases. J Investig Allergol Clin Immunol 2010;20:162–5). We report a 20-year-male patient who presented with acute myocardial infarction following a wasp sting at our institute. ECG showed non-ST-elevation myocardial infarction. Symptoms settled with hydrocortisone and adrenaline. Coronary angiogram revealed normal epicardial coronaries.

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Dilation of atria occurs in patients with valvular heart disease, especially in rheumatic mitral regurgitation, mitral stenosis, or tricuspid valve abnormalities. We report a case of giant left and right atrium in the context of rheumatic mitral stenosis and severe tricuspid regurgitation in a 68-year-old woman.

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