Apexcardiogram and Phonocardiogram in the Diagnosis of Left Atrial Myxoma

Abstract

SUMMARYA 40-year-old housewife with left atrial myxoma was reported and discussed. The following findings, as observed in our case, would be valuable in diagnosis of left atrial myxoma prior to cardiac catheterization: 1) a prolonged first heart sound in the phonocardiogram; 2) one or two notches in the systolic upstroke of the apexcardiogram; and 3) an extra positive wave just after the systolic downstroke of the apexcardiogram.At right heart catheterization, prominent C and V waves and a rapid Y descent are suggestive of left atrial myxoma in the absence of other features of significant mitral regurgitation. A marked spontaneous fl uctuation of the V wave in the pulmonary wedge pressure would be an additional feature suggesting left atrial myxoma. A right pleural effusion was observed to persist in our case and was attributed to impaired venous return from the right pulmonary veins by the tumor.

Impairment of Valvular Mechanics Due to Pedunculated Atrial Tumors

“…These pressure notches have been demonstrated repeatedly in the atrial and ventricular pressure curves of patients with atrial myxomas of the mixed stenosis and insufficiency type [Pitt el al., 1967;Malloch et al, 1970;Nasser el al., 1972a, b]. In addition, systolic and diastolic apical impulse notching, as demonstrated by apex cardiography, has been shown to result from the same phenomenon [Hashiba et al, 1970;Ryan, 1972;Craige and Algary, 1972;Becker and Conti, 1971].…”