Case report

Atrial myxoma presenting with orthostatic hypotension in an 84-year-old Hispanic man: a case report

Ralph M Vicari¹ , Enrique Polanco¹ , Norberto Schechtmann¹ , José O Santiago¹ , Kautilya Shaurya² , Michael Halstead³ , Danielle Marszal⁴ , Tamsin Grosskreutz⁵ and Shalini Thareja⁶

¹  Mima Century Research, E. Sheridan Rd, Melbourne, FL 32901, USA

²  Miller School of Medicine, NW 14th St, Miami, FL 33136, USA

³  Tulane University, St Charles Avenue, New Orleans, LA 70118, USA

⁴  University of Central Florida, Central Florida Blvd, Orlando, FL 32816, USA

⁵  Florida Atlantic University, Glades Rd, Boca Raton, FL 33431, USA

⁶  Columbia University, Haven Ave, New York, NY 10032, USA

author email corresponding author email

Journal of Medical Case Reports 2009, 3:9328doi:10.1186/1752-1947-3-9328

Published:	14 December 2009

Abstract

Introduction

Left atrial myxomas remain the most common benign primary cardiac tumors, and these cardiac growths can masquerade as mitral stenosis, infective endocarditis and collagen vascular disease. Atrial myxomas are found in approximately 14-20% of the population and can lead to embolization, intercardiac obstructions, conduction disturbances and lethal valve obstructions.

Case presentation

An 84-year-old Hispanic man presented with complaints of dizziness upon standing, and with no prior history of heart murmurs, syncope, shortness of breath, or chest pain. Physical examination revealed evidence of orthostatic hypotension and a soft grade 1/6 systolic murmur at the left sternal border. A transthoracic echocardiogram revealed a large atrial myxoma occupying the majority of the left atrium, with the posterior border of the large atrial mass defined by eccentric mitral regurgitation identified during cardiac catheterization. Left atrial myxoma excision was performed, revealing a 7 × 6.5 × 4.5 cm atrial tumor attached to a 4 × 3 × 2 cm stalk of atrial septal tissue.

Conclusion

This patient didn't present with the common symptoms associated with an atrial myxoma, which may include chest pain, dyspnea, orthopnea, peripheral embolism or syncope. Two-dimensional echocardiography provides substantial advantages in detecting intracardiac tumors. We recommend a two-dimensional echocardiogram in the workup of orthostatic hypotension of unknown etiology after the common causes such as autonomic disorders, dehydration, and vasodilative dysfunctions have been ruled out. By illustrating this correlation between orthostasis and an atrial myxoma, we hope to facilitate earlier identification of these intracardiac growths.