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CHEST PAIN: THE RIGHT DIAGNOSIS
1175 JACC April 5, 2016 Volume 67, Issue 13
FIT Clinical Decision Making CHEST PAIN: THE RIGHT DIAGNOSIS Poster Contributions Poster Area, South Hall A1 Sunday, April 03, 2016, 3:45 p.m.-4:30 p.m. Session Title: FIT Clinical Decision Making: Non-Invasive Imaging and Valvular Heart Disease Abstract Category: Non Invasive Imaging Presentation Number: 1232-271 Authors: Amitabh C. Pandey, John J. Carey, Jess L. Thompson, University of Arizona, Tucson, AZ, USA
Background: The majority of primary cardiac tumors are atrial myxomas, and are primarily located in the left atrium. Right atrial myxomas are rarer, and patients can remain asymptomatic or present with nonspecific constitutional symptoms, pulmonary embolism, pulmonary hypertension, Budd-Chiari syndrome and potentially lethal valve obstructions. Case: A 32 year-old female presented with dyspnea and constant, non-radiating chest pressure along the left sternal border associated with subjective palpitations. She complained of a racing heartbeat that would not slow down after performing her routine exercises. The patient was taking oral contraceptives. She had traveled by plane one-week prior to presentation.
Decision Making: She was afebrile with a heart rate of 87 beats per minute, blood pressure 149/72 mmHg, respiratory rate of 17 breaths per minute and pulse oxygen saturation of 99% on room air. Cardiac exam revealed no murmurs or extra heart sounds. Pulmonary exam significant for a slight decrease in breath sounds in the right lower lobe. A mildly elevated troponin I was observed at 0.18 ng/mL. CT angiogram chest showed a large embolus in the distal main right pulmonary artery straddling the right upper and lower lobe pulmonary artery divisions and almost completely occluding the segmental arteries. Transthoracic echocardiogram showed a large, highly mobile mass attached to the right inter-atrial septum prolapsing through the tricuspid valve in diastole highly suggestive of a cardiac myxoma. The patient underwent median sternotomy, right atrial mass resection, repair of atrial septal defect with pericardium and pulmonary embolectomy with histology of all specimens was confirming benign myxoma.
Conclusions: Embolization of intra-cardiac tumors is a common manifestation occurring more often with left sided then right-sided tumors secondary to the high flow state of the left heart.
FIT Clinical Decision Making CHEST PAIN: THE RIGHT DIAGNOSIS Poster Contributions Poster Area, South Hall A1 Sunday, April 03, 2016, 3:45 p.m.-4:30 p.m. Session Title: FIT Clinical Decision Making: Non-Invasive Imaging and Valvular Heart Disease Abstract Category: Non Invasive Imaging Presentation Number: 1232-271 Authors: Amitabh C. Pandey, John J. Carey, Jess L. Thompson, University of Arizona, Tucson, AZ, USA
Background: The majority of primary cardiac tumors are atrial myxomas, and are primarily located in the left atrium. Right atrial myxomas are rarer, and patients can remain asymptomatic or present with nonspecific constitutional symptoms, pulmonary embolism, pulmonary hypertension, Budd-Chiari syndrome and potentially lethal valve obstructions. Case: A 32 year-old female presented with dyspnea and constant, non-radiating chest pressure along the left sternal border associated with subjective palpitations. She complained of a racing heartbeat that would not slow down after performing her routine exercises. The patient was taking oral contraceptives. She had traveled by plane one-week prior to presentation.
Decision Making: She was afebrile with a heart rate of 87 beats per minute, blood pressure 149/72 mmHg, respiratory rate of 17 breaths per minute and pulse oxygen saturation of 99% on room air. Cardiac exam revealed no murmurs or extra heart sounds. Pulmonary exam significant for a slight decrease in breath sounds in the right lower lobe. A mildly elevated troponin I was observed at 0.18 ng/mL. CT angiogram chest showed a large embolus in the distal main right pulmonary artery straddling the right upper and lower lobe pulmonary artery divisions and almost completely occluding the segmental arteries. Transthoracic echocardiogram showed a large, highly mobile mass attached to the right inter-atrial septum prolapsing through the tricuspid valve in diastole highly suggestive of a cardiac myxoma. The patient underwent median sternotomy, right atrial mass resection, repair of atrial septal defect with pericardium and pulmonary embolectomy with histology of all specimens was confirming benign myxoma.
Conclusions: Embolization of intra-cardiac tumors is a common manifestation occurring more often with left sided then right-sided tumors secondary to the high flow state of the left heart.