History and exam
Key diagnostic factors
common
presence of risk factors
Key risk factors include FHx, age 40 to 60 years, and female sex.
dyspnoea
One study found dyspnoea to be the most common symptom and present in >50% of patients.[8]
syncope
dizziness
Common initial symptoms are related to mitral valve obstruction (dizziness, syncope, pulmonary oedema, CHF), which is present in >50% of patients.[4]
CHF/pulmonary oedema
Common initial symptoms are related to mitral valve obstruction (dizziness, syncope, pulmonary oedema, CHF), which is present in >50% of patients.[4]
embolic manifestations
Embolic manifestations are present in 16% to 27% of patients.[4][8]
Embolisation of cardiac myxomas is more likely to occur in patients presenting with preoperative atrial fibrillation and in papillary-type tumours that are smaller in size.[11] The presence of an irregular or friable (villous) surface is associated with an increased risk of embolisation.[4][8]
systolic or diastolic murmur
In one study the most common auscultation findings were systolic murmur (in 50% of patients) followed by loud first heart sound (32%), an opening snap (26%), and a diastolic murmur (15%).[8]
uncommon
tumour plop
A tumour plop may be heard in up to 15% of patients.[4]
Other diagnostic factors
common
weight loss
About 34% of patients have constitutional or systemic symptoms (fever, weight loss, fatigue, myalgia, arthralgia, Raynaud's phenomenon).[4]
fatigue
About 34% of patients have constitutional or systemic symptoms (fever, weight loss, fatigue, myalgia, arthralgia, Raynaud's phenomenon).[4]
fever
arthralgia
About 34% of patients have constitutional or systemic symptoms (fever, weight loss, fatigue, myalgia, arthralgia, Raynaud's phenomenon).[4]
Raynaud's phenomenon
About 34% of patients have constitutional or systemic symptoms (fever, weight loss, fatigue, myalgia, arthralgia, Raynaud's phenomenon).[4]
loud first heart sound
In one study the most common auscultation findings were systolic murmur (in 50% of patients) followed by loud first heart sound (32%), an opening snap (26%), and a diastolic murmur (15%).[8]
opening snap
In one study the most common auscultation findings were systolic murmur (in 50% of patients) followed by loud first heart sound (32%), an opening snap (26%), and a diastolic murmur (15%).[8]
uncommon
Carney's complex
intra-cerebral aneurysm
There have been case reports on the presence of intra-cerebral aneurysms in association with atrial myxoma.[1]
Risk factors
strong
female sex
Myxomas are more common in women than in men, with a ratio of 3:1.[4]
age 40-60 years
The incidence of myxomas peaks between 40 and 60 years of age.
weak
family history of atrial myxoma
Some cardiac myxomas are familial, and they have been described in relation to Carney's complex. This is an autosomal-dominant condition associated with cardiac myxomas, myxomas in other regions (cutaneous or mammary), hyperpigmented skin lesions, hyperactivity of the adrenal or testicular glands, and pituitary tumours.
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