Myxoma

Overview

A myxoma is a noncancerous, irregularly shaped tumor in the upper left or right side of the heart, usually on the atrial septum, the wall separating the two sides. A myxoma is a primary heart tumor, that is, it started within the heart. (Most heart tumors start somewhere else.) Primary cardiac tumors are rare, but myxomas are the most common type of these. Roughly 75 percent of them appear in the left atrium. Right atrial myxomas are sometimes linked with tricuspid stenosis andatrial fibrillation.

Symptoms

Symptoms often accompany a change in body position. Symptoms of a myxoma may include:

  • Breathing difficulty when lying flat or when asleep
  • Chest pain or tightness
  • Dizziness or fainting
  • Palpitations
  • Shortness of breath with activity
  • Blueness of skin, especially on the fingers (Raynaud's phenomenon)
  • Anemia
  • High white blood cell count
  • Low platelet count
  • Cough
  • Curvature of nails accompanied by soft tissue swelling (clubbing) of the fingers
  • Fever
  • Fingers that change color upon pressure or with cold or stress
  • General discomfort (malaise)
  • Joint pain
  • Swelling in any part of the body
  • Weight loss without trying

The symptoms of left atrial myxomas are similar to those of mitral stenosis. Right atrial myxomas rarely produce symptoms until they are at least five inches wide. However, since many of these symptoms can be symptoms of other conditions, thorough testing is necessary to correctly diagnose.

Risks

A myxoma may cause an embolism if its cells break off and move through the bloodstream. This could block blood flow or allow the tumor to grow elsewhere. Pieces of the tumor can move to the brain, eye or limbs. If the tumor grows inside the heart, emergency surgery may be necessary to prevent sudden death.

More women than men have myxomas, especially women between the ages of 40 and 60. Perhaps 1 in 10 myxomas are inherited (familial myxomas). These often occur in more than one part of the heart simultaneously, and often cause symptoms at a younger age, particularly in males in their 20s.

Complications from myxomas also are possible. These may include:

  • Arrhythmias (dysrhythmia)
  • Pulmonary edema
  • Peripheral emboli
  • Metastasis of the tumor
  • Blockage of the mitral heart valve

Diagnosis

A doctor or nurse will perform a physical exam and listen to your heart through a stethoscope. Abnormal heart sounds or a murmur may be heard, and may change when you change your body position. Imaging tests may include:

  • Chest X-ray
  • CT chest scan  
  • ECG
  • Echocardiogram
  • Doppler study
  • Heart MRI
  • Left heart angiography
  • Right heart angiography
  • Complete blood count (CBC) 
  • Erythrocyte sedimentation rate (ESR) 

Treatment

Surgery is needed to remove the tumor. Some people also will need the mitral valve replaced, which can be done at the same time. If surgery does not remove all of the tumor cells, myxomas may return.

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