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Atrial myxoma

 

An atrial myxoma is a noncancerous tumor in the upper left or right side of the heart. It most often grows on the wall that separates the two sides of the heart. This wall is called the atrial septum.

A myxoma is a primary heart (cardiac) tumor. This means that the tumor started within the heart. Most heart tumors start somewhere else.

Primary cardiac tumors are rare. Myxomas are the most common type of these rare tumors. About 75% of myxomas occur in the left atrium of the heart. They most often begin in the wall that divides the two upper chambers of the heart. The rest are in the right atrium. Right atrial myxomas are sometimes linked with tricuspid stenosis and atrial fibrillation.

Myxomas are more common in women. About 1 in 10 myxomas are passed down through families (inherited). These tumors are called familial myxomas. They tend to occur in more than one part of the heart at a time, and often cause symptoms at a younger age.

Symptoms

 

Symptoms may occur at any time, but most often they go along with a change in body position.

Symptoms of a myxoma may include:

  • Breathing difficulty when lying flat
  • Breathing difficulty when asleep
  • Chest pain or tightness
  • Dizziness
  • Fainting
  • Sensation of feeling your heart beat (palpitations)
  • Shortness of breath with activity

The symptoms and signs of left atrial myxomas often mimic mitral stenosis. Right atrial myxomas rarely produce symptoms until they have grown to be at least 5 inches wide.

Other symptoms may include:

  • Blueness of skin, especially on the fingers (Raynaud's phenomenon)
  • 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

 

Exams and Tests

 

The 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. These sounds may change when you change body position.

Imaging tests may include:

  • Chest x-ray
  • CT scan of chest
  • ECG
  • Echocardiogram
  • Doppler study
  • Heart MRI
  • Left heart angiography
  • Right heart angiography

You may also need blood tests including:

  • Complete blood count (CBC) - may show anemia and increased white blood cells
  • Erythrocyte sedimentation rate (ESR) - may be increased

 

Treatment

 

Surgery is needed to remove the tumor. Some people will also need the mitral valve replaced. This can be done during the same surgery.

Myxomas may come back if surgery does not remove all of the tumor cells.

 

Outlook (Prognosis)

 

A myxoma is not cancer, but complications are common.

Untreated, a myxoma can lead to an embolism (tumor cells breaking off and traveling in the bloodstream). This can lead to a blockage of blood flow or cause the tumor to grow in another part of the body. Pieces of the tumor can move to the brain, eye, or limbs.

If the tumor grows inside the heart, it can block blood flow. This may require emergency surgery to prevent sudden death.

 

Possible Complications

 

  • Arrhythmias
  • Pulmonary edema
  • Peripheral emboli
  • Spread (metastasis) of the tumor
  • Blockage of the mitral heart valve

 

 

References

McManus B. Primary tumors of the heart. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap74.

McKenna W. Diseases of the myocardium and endocardium. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 60.

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  • Left atrial myxoma

    Left atrial myxoma

    illustration

  • Right atrial myxoma

    Right atrial myxoma

    illustration

    • Left atrial myxoma

      Left atrial myxoma

      illustration

    • Right atrial myxoma

      Right atrial myxoma

      illustration

    A Closer Look

     

      Self Care

       

        Tests for Atrial myxoma

         
           

          Review Date: 5/13/2014

          Reviewed By: Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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