International Journal of Cardiology 190 (2015) 148–150

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Letter to the Editor

Left atrial myxoma presenting as acute coronary syndrome G. Cannavà, A. Currò ⁎ Cardiac Intensive Care, Piemonte-Papardo Hospital, Messina, Italy

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Article history: Received 15 April 2015 Accepted 16 April 2015 Available online 18 April 2015 Keywords: Left atrial myxoma Acute coronary syndrome Coronary embolization Transoesophageal echocardiography

Myxomas are the most common primary cardiac tumors. Most myxomas have a benign clinical course, but it is possible a coronary embolization, a potentially lethal complication [1–18]. We present the case of a young man of 48 years, who came at hospital for anginal pain with ECG abnormalities (Fig. 1A) and a small increase in markers of cardiac necrosis (ACS NSTEMI). From his history we learned that he was a modest former smoker, his noble was positive

for diabetes, was affected by psoriasis from a long time and from allergic asthma [19–30]. The patient underwent to coronary angiography, which showed left coronary artery free from injuries and right coronary artery with small lesions hemodynamically insignificant (Fig. 1B). Transthoracic echocardiography (Fig. 1C) showed a left atrial mass arising from the atrial septum, compatible with the diagnosis of Cardiac Myxoma. A CT scan and a transesophageal echocardiography confirmed the diagnosis [31–36]. After cardiac surgery with removal of the tumor the patient at one year of follow-up was asymptomatic. For the absence of coronary lesions in the left coronary artery, in correspondence of the left ECG leads showing dynamic changes, we hypothesize that the clinical manifestation was due to a coronary embolization from the Myxoma. Moreover the absence of coronary emboli may be justified from the tumors' tissue composition, making them dissolving [13–15]. Also this case shows the potential lethality of cardiac myxomas.

Conflict of interest The authors report no relationships that could be construed as a conflict of interest.

Fig. 1. Panel A: ECG shows ischemia in the anterolateral leads. Panel B: Transesophageal echocardiography shows a left atrial myxoma. Panel C: Coronary angiography which shows the left coronary artery with no injuries, and the right coronary artery with small lesions hemodynamically insignificant.

⁎ Corresponding author at: Cardiac Intensive Care, Azienda Ospedaliera Ospedali Riuniti Papardo Piemonte, Viale Europa n.45, 98123 Messina, Italy. E-mail address: [email protected] (A. Currò).

http://dx.doi.org/10.1016/j.ijcard.2015.04.136 0167-5273/© 2015 Published by Elsevier Ireland Ltd.

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Fig. 1 (continued).

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Left atrial myxoma presenting as acute coronary syndrome.

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