DefinitionAn atrial myxoma is a noncancerous tumor in the upper left or right side of the heart. It grows on the wall that separates the two sides of the heart. This wall is called the atrial septum.
Causes, incidence, and risk factorsA 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, usually beginning in the wall that divides the two upper chambers of the heart. The rest are in the right atrium. Right atrial myxomas are sometimes associated with tricuspid stenosis and atrial fibrillation.Myxomas are more common in women. About 1 in 10 myxomas are passed down through families (inherited). Such 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.
SymptomsSymptoms 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 flatBreathing difficulty when asleepChest pain or tightnessDizzinessFaintingSensation of feeling your heart beat (palpitations)Shortness of breath with activityThe 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 the fingers (Raynaud's phenomenon)CoughCurvature of nails accompanied with soft tissue swelling (clubbing) of the fingersFeverFingers that change color upon pressure or with cold or stressGeneral discomfort (malaise)Losing weight without tryingJoint painSwelling - any part of the body
Signs and testsThe doctor or nurse will perform a physical exam and listen to your heart using a tool called 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-rayCT scan of chestECGEchocardiogramDoppler studyHeart MRILeft heart angiographyRight heart angiographyBlood tests:A complete blood count may show anemia and increased white blood cells. The erythrocyte sedimentation rate (ESR) is increased.
TreatmentSurgery is needed to remove the tumor. Some patients will also need their mitral valve replaced. This can be done during the same surgery.Myxomas may come back if surgery did not remove all of the tumor cells.
Expectations (prognosis)Although a myxoma is not cancer, complications are common. Untreated, a myxoma can lead to an embolism (tumor cells breaking off and traveling with the bloodstream), which can block 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.
ComplicationsArrhythmiasPulmonary edemaPeripheral emboliSpread (metastasis) of the tumorBlockage of the mitral heart valve
ReferencesMcManus 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: Saunders Elsevier; 2011:chap74.McKenna W. Diseases of the myocardium and endocardium. In:Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 60.