Overview

Myxoma is a rare benign tumour that typically develops in the heart, most commonly in the left atrium. It is composed of abnormal connective tissue and can obstruct blood flow or cause valve dysfunction, leading to symptoms such as chest pain, shortness of breath, and stroke-like symptoms if fragments break off. Surgical removal is the primary treatment.

A cardiac myxoma is the most frequent primary heart tumours in adults. Myxomas are not malignant, but they might still be fatal if they affect how your heart works. These patients require surgery to remove the tumour and avoid significant side effects. Obstruction, emboli, and constitutional symptoms (such as fever and weight loss) are several problems linked to atrial myxomas.

[caption id="attachment_22563" align="alignnone" width="1159"] Myxoma in the left atrium[/caption]

Most patients with atrial myxomas are between the ages of 30 and 60. Compared to males and persons identified as male at birth (DMAB), women and people designated as female at birth (DFAB) have a higher prevalence of atrial myxomas.

Atrial myxomas have a velvety, pedunculated appearance under the microscope. The myxoma weighs between 15 and 180 g and has a diameter that ranges from 1 to 15 cm.

Causes of Myxoma

Atrial myxoma occurs in relatively erratic clusters, and its specific aetiology is frequently unclear. Genetic factors play a role in familial atrial myxomas exhibiting autosomal dominant transmission. It has been determined that Carney's syndrome, a rare genetic illness marked by black skin patches and tumours in the skin, nerves, endocrine glands, and heart, is genetically heterogeneous in origin and is brought on by errors in several genes.

Irrespective of age or gender, it is believed that Carney's syndrome causes around 7% of all atrial myxomas. The reason is believed to be abnormalities in the Ki-ras oncogene located on chromosome 12 and the short arm of chromosome 2 known as the Carney. Atrial myxoma can affect several parts of the heart at once.

[caption id="attachment_22564" align="alignnone" width="950"] Causes of Myxoma[/caption]

Symptoms of Atrial Myxoma

Atrial myxomas typically do not have any symptoms when they first appear. When an imaging test such as echocardiography (ECG), magnetic resonance imaging (MRI), or computed tomography (CT) is performed for another cause, they are frequently unintentionally found.

The signs and symptoms of a myxoma change depending on where it is in your heart and how it impacts your body.

- Fever: A fever can occur due to inflammation or infection associated with the myxoma.
- Lethargy (lack of energy): Fatigue and a general lack of energy can be caused by the reduced efficiency of the heart in pumping blood due to the presence of the tumour.
- Night sweats: Night sweats are a non-specific symptom and can occur due to various underlying conditions, including myxomas.
- Raynaud's phenomenon: Raynaud's phenomenon is a condition where the fingers or toes may turn white, blue, or purple in response to cold temperatures or stress. While it is not a direct symptom of myxomas, it may be associated with certain heart conditions.
- Shortness of breath with physical activity: Myxomas can obstruct blood flow in the heart, leading to reduced oxygen supply to the body during physical exertion, which can result in shortness of breath.
- Shortness of breath or fainting when you stand: This symptom occurs because the myxoma can obstruct blood flow through the mitral valve, leading to reduced cardiac output when you change positions from sitting or lying down to standing.
- Weight loss: Unintentional weight loss can occur in some cases of myxomas, likely due to reduced appetite and energy expenditure associated with heart-related symptoms.
- Palpitations: The patient may experience rapid, erratic, strong, or irregular heartbeats.

Treatment for Myxoma

- Surgery. The preferred course of therapy for atrial myxomas is immediate surgical removal due to the possibility of cardiovascular problems and embolisation.
[caption id="attachment_22565" align="alignnone" width="856"] Treatment for Myxoma[/caption]
- Pericardial Patch. Placing a pericardial patch can aid in correcting flaws that primary closure cannot correct. The removed tumour is submitted to pathology to rule out the presence of metastases or further malignant tumours. Recurrent atrial myxoma is suggested to be treated with cardiac autotransplantation.
- Repair or Replacement of Valves. If the myxoma has damaged heart valves or caused other structural issues, the surgeon may repair or replace the affected valves during the same procedure.
- Follow-ups. However, within 10 to 15 years following their operation, 1% to 2% of patients experience the recurrence of myxomas. People with Carney's complex are more likely to experience recurrence. Because of this, if you have a history of myxomas, your healthcare professional will advise that you undergo routine imaging testing. These tests can identify the development of new myxomas and reduce your risk of difficulties in the future. Myxoma survivors are more likely to experience atrial arrhythmias and irregular heartbeats in the upper chambers.

The most frequent non-cancerous intracardiac tumours are cardiac myxomas. The surgical excision of the lesion is an option for therapy; the typical hospital stay is six to twenty days. For the surgical removal of atrial myxoma, open-heart techniques are employed.

When to Consult a Doctor

You can also get in touch with the expert cardiology doctors at Narayana Healthcare based in your city to get immediate attention and medical support during injuries, health disorders or any other health concern.

Conclusion

Although atrial myxoma is uncommon, it has a wide range of complications and clinical presentations that affect the heart, lungs, brain, and other organs. For patients with atrial myxomas, it's crucial to use an interdisciplinary strategy to maximise the result. Primary care doctors must do a comprehensive assessment. Once the tumour has been identified, radiologists and cardiologists can assist by using imaging techniques to characterise it better. Patients must be assessed by pulmonologists, cardiologists, and anesthesiologists for preoperative risk stratifications before surgical resection by cardiothoracic surgeons.

FAQs

Q. When should one consult a doctor? A. Immediately contact your doctor if you experience any myxoma symptoms. Instead of a myxoma, these symptoms can point to another cardiac issue. But before things worsen, getting tested and starting treatment for any heart condition is crucial.

Q. Why Does Atrial Myxoma Cause Stroke? A. Systemic embolism, which stops arteries and limits blood flow to specific organs, can be brought on by atrial myxoma. Ischemia is a condition in which the blood flow and oxygen supply are reduced. Following an embolism in the central nervous system, there is reduced blood flow, which leads to a stroke. Atrial myxoma typically manifests as an ischemic stroke, which can happen anywhere.

Q. Is Myxoma Treated Through Open-Heart Surgery? A. Atrial myxoma is typically treated with a median sternotomy and does not require open-heart surgery. It entails cutting into the sternum, a flat bone in the centre of the chest, to gain access to the heart as needed. In contrast, open heart surgery involves opening the chest to do procedures on the heart's arteries, valves, and muscles.

Q. What are the major symptoms of Myxoma? A. Major symptoms of atrial myxoma, a heart tumour, include cardiac irregularities, murmurs, chest pain, shortness of breath, palpitations, fainting, and stroke-like symptoms. Constitutional symptoms may include fever, weight loss, and joint pain.

Reference Links

- https://www.narayanahealth.org/blog/esophagitis-causes-symptoms-and-treatment/
- https://my.clevelandclinic.org/health/diseases/16976-esophageal-disorders