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Left Atrial Myxoma: A Rare Nonatherosclerotic Cause of Acute Myocardial Infarction

DOI: 10.1155/2013/407935

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Myocardial infarction from coronary artery embolism is a very rare but potentially lethal sequel of left atrial myxoma. Most atrial myxomas causing myocardial infarction are diagnosed retrospectively after a 2D echocardiogram is performed for assessment of myocardial function after a myocardial infarction. We present a relatively healthy 53-year-old male with anterolateral wall myocardial infarction and 100% occlusion at the proximal part of the obtuse marginal branch of the circumflex coronary artery that was subsequently reperfused. A 2D echocardiogram performed two days later revealed a left atrial mass, which was successfully resected and proven to be a myxoma. No recurrence of the tumor was seen on follow-up after four months. An automatic implantable cardioverter defibrillator was placed for residual ischemic cardiomyopathy with clinical improvement. 1. Introduction Primary cardiac neoplasms are rare, with an incidence of less than 0.2% in unselected patients at autopsy [1]. The majority of these tumors are benign myxomas located in the left atrium (80%) [2]. Rare coronary artery embolization from a cardiac myxoma usually involves either the right coronary artery (RCA) or the left anterior descending (LAD) coronary artery [3]. We report a case of a patient with 100% occlusion of the left circumflex (LCX) artery from a left atrial myxoma presenting as anterolateral wall myocardial infarction. 2. Case Report A 53-year-old male with no significant past medical history presented with severe chest pain after exertion, associated with diaphoresis, dyspnea, cough, and three episodes of syncope. He denied smoking, use of alcohol, and illicit substances. He has no family history of coronary artery disease. On admission, he was in mild distress with blood pressure of 115/70?mmHg, heart rate of 100 beats per minute, respiratory rate of 20 breaths per minute, and temperature of 97.2°F. Body mass index was 30?kg/m2. There was no jugular venous distention. He had bibasilar rales on lung exam. Cardiac examination revealed a normal heart rate, regular rhythm with no clicks, gallops, or murmur. The rest of the physical examination was normal. The 12-lead electrocardiogram showed ST-segment elevation in the anterolateral leads with reciprocal changes in the inferior leads. Chest radiograph was normal. Initial set of cardiac enzymes were normal as he presented within 30 minutes from onset of chest pain. Cardiac catheterization revealed no evidence of coronary artery disease in the RCA, left main coronary artery, nor the LAD artery. However, the proximal obtuse

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