Clinical Images
A Rare Cause of Platypnea and Atrial Fibrillation
Sophia MyTrang Nguyen, MD; Shalini Bhambani-Lal, MD; Randall Edson, MD, MACP
December 12, 2014
A 60 year old veteran pilot with heavy tobacco use and anxiety presented with palpitations and progressive dyspnea that improved in the supine position. Physical examination revealed an afebrile, tachypneic man with a rapid heart rate and irregularly irregular rhythm, blood pressure of 128/79 mmHg, and elevated jugular venous pressure. Following rate control, a Grade II diastolic murmur along with a “plop” was noted during cardiac auscultation. Laboratory assessment showed normal blood cell counts, electrolytes, ESR, TSH, cardiac enzymes and renal function. Transesophageal echocardiogram revealed a large 5 cm x 2.7 cm x 2.7 cm mobile mass attached to the inter-atrial septum, with intermittent mitral inflow obstruction and global left ventricular hypokinesis. Coronary angiography demonstrated multi-vessel disease.
Figure 1: Left atrial myxoma prolapsing through the mitral valve causing functional mitral stenosis.
Figure 2: Left atrial myxoma attached to inter-atrial septum with moderate to severe mitral regurgitation.
Figure 3: Excised gross specimen measuring 5.2 cm x 3.4 cm x 2.5 cm.
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References
Kolluru A, Desai D, Cohen GI. The Etiology of Atrial Myxoma Tumor Plop. J Am Coll Cardiol. 2011 May 24;57(21):e371
Reynen K. Cardiac myxomas. New Eng J Med. 1995;333(24):1610–1617
Author Biographies
Sophia MyTrang Nguyen is a resident in the Department of Medicine at California Pacific Medical Center (CPMC) in San Francisco, California. She attended medical school at the University of Colorado at Denver.
Shalini Bhambani-Lal is a fellow in the Department of Cardiology at California Pacific Medical Center in San Francisco, California. She attended Harvard Medical School and completed her Internal Medicine Residency at the University of Southern California.
Randall Edson is the Program Director for the Internal Medicine residency program at CPMC. He completed his Internal Medicine Residency and Infectious Disease Fellowship at the Mayo School of Graduate Medical Education and served as Infectious Disease Fellowship Director and Associate Program Director of the Internal Medicine Residency Program for 25 years before becoming Program Director at CPMC.