The Dangers of Cardiac Myxomas

Abstract

A variety of cardiac tumors have been acknowledged in the literature since the 16th century as rare forms of cardiac disease. Of the primary tumors, myxomas account for at least 30% to 50% of benign tumors. Despite significant advances in cardiac diagnostics leading to early recognition of myxomas, the potential for deleterious effects secondary to embolic complications remains high. The purpose of this paper is to provide nurses with an understanding of the epidemiology, pathology, clinical presentation, and assessment of individuals with cardiac myxomas. A case presentation is used to illustrate how the misdiagnosis of cardiac myxoma led to a delay in patient treatment. Prompt recognition, diagnosis, and treatment are important in improving patient outcomes and quality of life. Due to the infrequency of cardiac myxomas, ensuring appropriate preoperative and postoperative nursing care to the patient with a cardiac myxoma is essential.

Biatrial Approach Provides Better Outcomes in the Surgical Treatment of Cardiac Myxomas

“…In general, there are no specific physical examinations and/or laboratory findings related to myxomas. An auscultation finding, a "tumor plop" sound, which is an early diastolic murmur due to penetrating myxoma into the ventricle, is considered pathognomonic [1,12,18] . The symptoms may be intermittent, resulting from occasional prolapse of pedunculated and mobile tumors through the atrioventricular valves into the ventricle.…”

“…Although myxomas are histologically benign, this type of tumor carries the risk of systemic embolization with subsequent cerebral or peripheral infarctions, intracardiac obstructions, syncope, and sudden death [11,12] . Therefore, surgical treatment for cardiac myxomas should be performed as soon as possible after diagnosis.…”

Surgical Resection of Atrial Myxomas

“…Although atrial myxomas are benign, if they are left untreated, syncope and even sudden death can occur if the tumor temporarily occludes the orifice of the mitral valve and blocks blood flow to the left ventricle 5 . Damage to the leaflets of the mitral valve is possible if a mobile myxoma tumor rubs against the cusp of the valve; this can necessitate mitral valve repair or replacement at the time the myxoma is removed 7 . Clinical signs of right atrial myxomas often mimic those of tricuspid valve stenosis and right‐sided heart failure, including ascites, peripheral edema, and hepatomegaly.…”

“…The majority of myxoma‐related embolic events are cerebrovascular accidents or transient ischemic attacks as emboli pass from the systemic circulation into the cerebral circulation. Myxoma‐related emboli or tumor fragments also can affect the coronary, retinal, iliac, and femoral arteries 4,5,7 …”

“…Approximately 50% of patients with a myxoma will experience systemic symptoms, including fatigue, weight loss, fever, and joint pain. The cause of systemic symptoms is not understood fully but is believed to be an autoimmune response related to the presence of the tumor 7 …”