Cardiac Myxoma - An Overview

Introduction:

Cardiac myxoma is a sporadic condition and is most likely seen in women in the third to fifth decade of life. Cardiac myxoma is a benign condition, which means a kind of tumor that does not invade neighboring tissues. Cardiac myxoma usually is found in the atrium of the heart. The heart is sectioned into four chambers, and the upper two compartments are called the right and left atrium. The lower two compartments are called right and left ventricles. Most cases have been documented in the left atrium ( 75 percent) than in the right atrium (25 percent). The majority of the atrial myxomas are benign and can be removed by surgical resection. However, early detection of cardiac myxoma is quite a task since it generally ends up in misdiagnosis due to its nature of nonspecific symptoms. The most severe and life-threatening complication of myxoma can be any neurological involvement resulting from a small fragmentation of myxoma, thus leading to a cerebral infarct.

What Are the Causes of Cardiac Myxoma?

A myxoma is an irregular lump of flesh with a smooth and yellowish red surface. It is a kind of tumor because of its abnormal growth pattern. When the myxoma or tumor starts growing in the heart, it is called cardiac myxoma. There is no clear-cut evidence or proof that defines the causes leading to the development of myxoma. A robust blend of environmental and genetic factors has been studied for the reason of cardiac myxoma. Because the exact etiology is not known, cardiac myxomas are mostly sporadic or abrupt in occurrence. Abnormalities in the gene have been researched and found to contribute to the formation of cardiac myxoma.

What Are the Signs and Symptoms Of Cardiac Myxoma?

Cardiac myxoma can manifest multiple signs and symptoms that hugely are based on the size and location of the myxoma or growth. Symptoms of cardiac myxoma may range from being asymptomatic to unspecific to sudden death. In asymptomatic cases that account for almost 20 percent, cardiac myxoma is an incidental finding. The spectrum of signs and symptoms can be exhaustive, but most patients present with one or more triad of symptoms, generally known as the myxoma triad. Myxoma triad includes cardiac obstruction, constitutional signs, and embolization. Embolization results because of detachment or fragmentation of tumor. Embolization has been documented as a significant complication occurring in 30 to 50 percent of cases. Embolism can present itself in any extremity, but the most common site of involvement in the central nervous system. Mentioned below are a few of the classical signs and symptoms of cardiac myxoma.

• Syncope.

• Difficulty in breathing.

• Pain in joints.

• Fatigue.

• Fever.

• Clubbing of fingers.

• Inflammation of blood vessels.

• Dizziness.

• Palpitations.

• Fainting.

• Difficulty in breathing while sleeping or lying on one side.

• Swelling of the feet.

• Swelling of the abdomen.

• Water retention in the body.

• Diarrhea.

• Spotty pigmentation in the skin.

• Unintentional weight loss.

• Malaise.

• Thyroid.

• Arrhythmia (irregular heartbeats).

• Cough.

• Enlargement of the liver.

• Stroke.

How Is Cardiac Myxoma Diagnosed?

Multiple diagnostic tools help in assessing the presence of cardiac myxoma. The majority of them are based on radiology. Electrocardiography and two-dimensional echocardiography are some of the pivotal diagnostic tools. A thorough clinical examination with the consultation of specialists like neurologists, pulmonologists is required in cases of involvement of lung, neural or infective endocarditis cases.

• Echocardiography to detect the size location as well as mobility of the tumor. It also helps to know about the circulatory obstruction caused.

• Cardiac magnetic resonance imaging.

• Computed tomography to check the minor changes within the tumor.

• Coronary angiography is mainly done to develop a line of treatment.

• Transvenous biopsy.

What Is the Treatment of Cardiac Myxoma?

A surgical excision of the myxoma is the primary choice of treatment. Surgical excision can avoid any cardiovascular complication or embolism. The removed tumor is sent for biopsy post-surgery. Cardiac autotransplantation is the proposed treatment in cases of recurrence. Recurrence is primarily seen in the hereditary type of myxoma. The recurrence rate is about 10 to 20 percent due to abnormal DNA patterns associated with the genetic classification of myxoma. Nevertheless, the latest trends in the tight management of cardiac myxoma are mentioned below. Immediate treatment will avoid thromboembolic complications and ensure a predictable prognosis with regular follow-ups.

• Pericardial patch.

• Aortic cross-clamping.

• Resection of the atrial wall.

What Are the Complications of Cardiac Myxoma?

There are developments in the investigative field of cardiac myxoma. But unfortunately, there is no crystal clear way to diagnose cardiac myxoma at the initial stage. Underlying cardiovascular symptoms and clinical manifestations, if addressed, may definitely aid in early diagnosis. If not, below mentioned are some of the complications of untreated or late diagnosis of cardiac myxoma. Death is due to symptoms that are presented but ignored, failure of the heart, or a mechanical obstruction in the pumping of the heart. Sudden death accounts for 15 % of untreated and undiagnosed cardiac myxoma cases.

• Congestive heart failure (occurs when the heart is unable to pump blood efficiently, leading to a buildup of fluid in the body).

• Tachycardia (abnormally fast heart rate).

• Bradycardia (abnormally slow heart rate).

• Infection of the heart.

• Embolization (movement of a blood clot or other foreign material through the bloodstream, leading to its blockage in a smaller blood vessel).

• Multiple clot formations.

• Rupture of the heart valves.

• Myocardial infarction (heart attack).

• Weakening of the heart muscles.

• Non-effectiveness of cardiac medications.

• Sudden cardiac arrest.

Conclusion:

Atrial myxoma is one of the rarest diseases encountered in clinical scenarios and has a vast range of clinical presentations in affected individuals. Treatment and diagnosis require an interdisciplinary approach in managing the outcome of individuals suffering from myxoma. The clinical emergency may arise from cerebral stroke because of an embolism which can easily lead to misdiagnosis in the case of myxoma. Echocardiography has been the most effective diagnostic means to reach a final diagnosis. The gold standard choice for diagnosis is echocardiography, which is indicated as a screening tool in cases of a neural stroke to rule out cardiac myxoma as a source of emboli. An extended follow-up is mandatory in order to resume everyday life.