Shaun Khanna, Aditya Bhat, Henry Chen and Gary Gan
Blacktown Hospital, Australia
Posters & Accepted Abstracts: J Clin Exp Cardiolog
Here, we explore a case of a 65-year-old female who presented to our facility with a constellation of symptoms including chest pain, dizziness and headache over the last day. An MRI brain was performed revealing multiple scattered focal sites of abnormal diffusion restriction in the posterior and anterior circulation with additional ischemic foci in the left cerebellar hemisphere. This was concerning for cardio-embolic source. Subsequently an echocardiogram revealed a large mass in the left atrium attached to the inter-atrial septum. Cardiothoracic surgery was consulted for excision of the atrial myxoma. In the interim, intravenous heparin infusion with a target low APTT (40-60 seconds) was commenced in light of risk of further embolism versus risk of hemorrhagic transformation of the ischemic stroke. In the interim, the patient was monitored with BD non-contrast CT Brain scans. The patient successfully had excision of the atrial myxoma and patch repair of the intra-atrial septum. Findings were of a gelatinous, friable tumor measuring 35Ã?25Ã?15 mm with histopathology consistent with atrial myxoma. The prevalence of cardiac tumors ranges from 0.001% to 0.3% with cardiac myxoma being the most common primary cardiac tumor with a 2:1 female preponderance. Cardiac myxomas, specifically atrial origin myxomas (75%) have several presentations with the most serious being systemic embolization through tumor thrombi and rarely tumor fragments. This phenomenon is currently responsible for approximately 0.5% of strokes. Further studies are required to delineate timing of surgery, in light of potential hemorrhagic transformation.
Shaun Khanna has completed his MBBS from Bond University and is currently pursuing his Master of Medicine at University of Sydney, Australia. He is also working at Blacktown Hospital as a Medical Officer and as a Conjoint Lecturer with the University of Western Sydney. His research interest is in arrhythmias and cardiovascular imaging.