History and exam

Key diagnostic factors

common

dyspnea

One study found dyspnea to be the most common symptom and present in >50% of patients.[8]

syncope

Common initial symptoms are related to mitral valve obstruction (dizziness, syncope, pulmonary edema, congestive heart failure [CHF]), which is present in >50% of patients.[4] Syncope alone has been found to be the presenting symptoms in 14% of patients.[8]

dizziness

Common initial symptoms are related to mitral valve obstruction (dizziness, syncope, pulmonary edema, CHF), which is present in >50% of patients.[4]

CHF/pulmonary edema

Common initial symptoms are related to mitral valve obstruction (dizziness, syncope, pulmonary edema, CHF), which is present in >50% of patients.[4]

embolic manifestations

Embolic manifestations are present in 16% to 27% of patients.[4][8]

Embolization of cardiac myxomas is more likely to occur in patients presenting with preoperative atrial fibrillation and in papillary-type tumors that are smaller in size.[11]​ The presence of an irregular or friable (villous) surface is associated with an increased risk of embolization.[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

tumor plop

A tumor 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 phenomenon).[4]

fatigue

About 34% of patients have constitutional or systemic symptoms (fever, weight loss, fatigue, myalgia, arthralgia, Raynaud phenomenon).[4]

fever

About 34% of patients have constitutional or systemic symptoms (fever, weight loss, fatigue, myalgia, arthralgia, Raynaud phenomenon).[4] Fever has been found to be present in 20% to 32% of patients.[4][8]

pallor

A sign of anemia. Anemia has been found to be present in 15% to 49% of patients.[4][8]

arthralgia

About 34% of patients have constitutional or systemic symptoms (fever, weight loss, fatigue, myalgia, arthralgia, Raynaud phenomenon).[4]

Raynaud phenomenon

About 34% of patients have constitutional or systemic symptoms (fever, weight loss, fatigue, myalgia, arthralgia, Raynaud 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 complex

Myxomas can be part of this familial multiple neoplasia, including myxomas at various sites, endocrine tumors, and spotty pigmentation of the skin.[5][6][7]

intracerebral aneurysm

There have been case reports on the presence of intracerebral 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 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 tumors.

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