Cerebral embolization from left atrial myxoma causing takotsubo cardiomyopathy complicated with congestive heart failure.
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ABSTRACT:
SUBMITTER: Konishi T
PROVIDER: S-EPMC8016002 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Case:A 69 year-old female with history of schizophrenia was transported to our hospital by ambulance due to coma. On arrival, she was hypotensive and tachycardic with a Glasgow coma scale score of 3 and a rectal core temperature of 40°C. Heatstroke was strongly suspected as the cause of the coma and hypotension. Active external cooling with an electric fan and cooled IV fluid administration were started. Her electrocardiogram (EKG) showed ST elevation in V2-6, II, III and aVF. Echocardiography revealed apical ballooning, which indicated Takotsubo cardiomyopathy. Coronary angiography indicated normal coronary arteries. Outcome:After admission to the intensive care unit, her cardiovascular status gradually improved and she was transferred to the psychiatric ward on day 36. Conclusion:Heatstroke and Takotsubo cardiomyopathy can share the same pathophysiology. Close evaluation of hemodynamic status and myocardial damage is critical for survival.
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| S-EPMC1861238 | biostudies-literature
Project description:We present a case of cerebral embolism associated with a left atrial myxoma that was treated with intravenous thrombolytic therapy. A 79-year-old right-handed man with no history of neurological or psychiatric illnesses was referred to our hospital because of confusion. He had been self-supported in the activity of daily living and could enjoy gardening until just before his admission. He had aphasia, left conjugate deviation, right hemiparesis, and right pathological reflexes. His NIHSS score was 24. Cranial DWI showed hyperintense lesions in the left middle cerebral artery territory, and MRA revealed left middle cerebral artery occlusion. We started treatment with the recombinant tissue plasminogen activator alteplase intravenously 3 h after the onset. However, the therapy was ineffective, and the NIHSS score was 25 on the second day. A transthoracic echocardiogram and heart MRI showed a left atrial myxoma. However, surgery was contraindicated because of the patient's poor general condition. Although intravenous recombinant tissue plasminogen activator is a reasonable treatment for stroke patients, even with a cardiac myxoma, we cannot always expect good effects, especially if the emboli are parts of the tumor itself. In this case, we could not perform an endovascular mechanical embolectomy; however, we speculate that mechanical embolus retrieval in cerebral ischemia might be effective in such cases.
| S-EPMC3335447 | biostudies-literature
Project description:Occurrence of left atrial myxoma with severe ventricular dysfunction without any obstructive coronary artery disease, as presented in our case, is very rare. It may be due to undiagnosed concomitant dilated cardiomyopathy or unknown cardiodepressant effect of myxoma which warrants further research.
| S-EPMC5067781 | biostudies-literature
Project description:BACKGROUND:A cardiac myxoma in a young person may pose a diagnostic challenge as symptoms may be variable and the differential diagnosis is wide. The differential diagnosis can include rheumatic mitral valve disease, pulmonary hypertension, endocarditis, myocarditis and vasculitis. CASE PRESENTATION:This case report involves a 49?years old female with a 2.8?cm?×?3.4?cm myxoma in the left atrium causing mitral valve obstruction. She presented with fatigue, fever of unknown origin, transient ischemic attack and shortness of breath. Prompt surgery is often recommended due to the risk of embolic complications or complete obstruction. Due to her symptoms, patient underwent successful cardiothoracic surgery to excise the myxoma within 2?weeks of confirmation by cardiac echocardiography. CONCLUSION:This case also emphasizes the diagnostic challenge as symptoms may be variable, ranging from fatigue, fever and shortness of breath to transient ischemic attack and at worst, sudden cardiac death. In conclusion, if a cardiac mass is suspected, echocardiography should be performed early. Surgical resection is curative and recurrence rate is very rare in sporadic isolated myxomas, however, recurrence can be higher in genetic diseases associated with increased frequency of myxomas such as Carney complex. This subpopulation of patients may present further research opportunity to learn more about the perioperative management of patients with myxomas such as determining the optimal time to surgical intervention and decision to anticoagulate.
| S-EPMC7059297 | biostudies-literature
Project description:Cardiac myxoma is the most common type of primary cardiac neoplasm. Over 70% of all cardiac myxomas originate from the left atrium (LA) and 18% from the right atrium (RA). Most myxomas present with constitutional, embolic, and obstructive manifestations. We are presenting a case where a part of myxoma got embolized intra-operatively. Using trans-oesophageal echocardiography, we were able to diagnose and image the transit of the tumor from the left ventricle to the left atrium. We removed the embolized tumor from the left atrium and prevented a dreaded complication like stroke, mesenteric ischemia, renal infarct or limb ischemia, which would have resulted in increased morbidity or mortality of the patient.
| S-EPMC6813701 | biostudies-other
Project description:Abstract We aimed to summarize the experience of totally thoracoscopic surgery for left atrial myxoma, together with analyzing the safety and feasibility. We retrospectively analyzed the clinical data of 15 patients with left atrial myxoma admitted to our hospital from October 2016 to October 2018. The auxiliary hole was located at the midline of the 5th intercostal space of the right chest. The endoscope hole was located at the front position of the fourth intercostal space. Specimens were sent to the pathology department for pathological examination. All the procedures were completed successfully. Extracorporeal circulation time was 46.5 ± 18.6 minute, cross-clamping time was 20.6 ± 6.7 minute, thoracic drainage fluid was 89+60.2 ml, ventilator assist time was 4.3 ± 2.6 hour, intensive care unit stay time was 14.5 ± 4.2 hour, the average postoperative hospital stay was 5.2 ± 1.2 day. There was no death, or red blood cell transfusion during and after surgery. No postoperative complications were reported by the patients. No recurrence of myxoma, residual shunt in the atrial septum and valvular lesions were found after 3months of postoperative cardiac ultrasound examination. Total thoracoscopic surgery for left atrial myxoma was less invasive with satisfactory cosmetic appearance with feasibility and safety. Besides, it caused no serious complications.
| S-EPMC8589240 | biostudies-literature
Project description:Left atrial myxoma is the common benign tumor of heart. Coronary arteries may supply these tumor. Considering the vascular nature of the tumor, acquired coronary cameral fistula(CCF) can be a possibility postexcision of the left atrial myxoma. Here, we discuss a case of 53-year-old female patient, who developed acquired CCF, following excision of the tumor and the role of transesophageal echocardiography intraoperatively in diagnosis.
| S-EPMC5965008 | biostudies-other