Right atrial myxoma as a possible cause of hemorrhagic stroke and sudden death

Abstract

Right atrial myxomas are rare primary tumors of the heart. They may remain asymptomatic or eventually cause constitutional signs and symptoms. Less frequently, obstruction of the tricuspid valve occurs, resulting in exertional dyspnea, syncope, or sudden death. Neurological manifestation as initial presentation of atrial myxomas is rarely, if ever, associated with right atrial myxomas and may be secondary to cerebral infarction, cerebral hemorrhage and, more rarely subarachnoid hemorrhage. We review the case of a previously unknown, middle-aged Nigerian man who presented to hospital with severe headache and sudden loss of consciousness. A clinical diagnosis of hypertensive hemorrhagic cerebrovascular accident was made. The patient died suddenly a few hours after presentation. Post-mortem examination revealed a small intracerebral hemorrhage in the left superior temporal lobe as well as a large right atrial myxoma, a ventricular septal defect in the muscular septum, and right ventricular hypertrophy. The liver showed fatty change while the kidneys showed evidence of benign nephrosclerosis. Right atrial myxomas may, therefore, be remotely considered as a cause of intracranial hemorrhage, especially in the presence of predisposing cardiac anomalies such as a ventricular septal defect. Similarly, being a known cause of right heart failure, sudden death, and other constitutional derangements, it may contribute significantly to disease outcome. Hence, it should be given due consideration in the differential diagnosis of cerebrovascular accidents.

Giant Left Atrial Myxoma Masquerading as Cough-Syncope Syndrome

“…These cardiovascular symptoms come from mitral valve obstruction and/or elevated left atrial pressure and include chest pain, dyspnea on exertion, orthopnea, and paroxysmal nocturnal dyspnea. 11 , 25 - 27 Other significant manifestations are neurological deficits from embolization of the myxoma, leading to events related to cerebral ischemia or infarction, 27 , 28 retinal artery occlusion, 29 and even sudden death. 21 However, patients can also present asymptomatically or with minimal cardiac symptoms.…”

Giant left atrial myxoma presenting with heart failure and pulmonary hypertension in a middle-age Nigerian man

“…Although atrial myxomas are often found in the left atrium, they can occur in the ventricles in a small proportion of people (1,3). Most atrial myxomas begin to produce symptoms when they become sufficiently large.…”

“…Interference with mitral flow mimics mitral stenosis, as in our patient, with massively dilated left atrium, pulmonary hypertension and chronic heart failure that progress over an appreciable duration of time (2,3). Other constitutional symptoms of atrial myxomas include fever, weight loss, digital clubbing, reduced platelet count, elevated erythrocyte sedimentation rate and abnormal serum proteins (3,4,11).…”

“…It is usually asymptomatic over a long period of time. Some documented clinical manifestations include cryptogenic stroke and obstructive symptoms such as mimics of aortic stenosis, mitral stenosis and severe pulmonary hypertension (2)(3)(4). There are few reports of atrial myxomas in Black Africans.…”

A large left atrial myxoma causing multiple cerebral infarcts

“…However, in the presence of an intracardiac shunt they can also be caused by a right-sided myxoma. Pulmonary embolism may originate from a right-sided myxoma 12 13…”