Atrial myxoma presenting with anterior ST-elevation myocardial infarction

A 76-year-old male with no past medical history presented with sudden onset of central chest pain. The ECG showed atrial fibrillation with marked anterior segment ST elevation (figure 1A). He was referred for primary PCI. (A) ECG taken by the ambulance prior to PCI. (B) Angiogram showing LAD prior to thrombectomy. (C) Angiogram showing LAD post thrombectomy. (D) Thrombus taken from LAD post thrombectomy. (E) ECHO showing atrial myxoma in left atrium, (F) MRI showing atrial myxoma in left atrium. Angiogram showed an occluded left anterior descending (LAD) in the mid-portion (figure 1B), the coronary arteries were otherwise normal, this was confirmed with IVUS. There was a large thrombus burden to the LAD, which was aspirated with a thrombectomy catheter (figure 1D). In the absence of coronary artery disease, the patient did not have any coronary stents inserted. Post-thrombectomy angiogram showed a normal LAD (figure 1C) Echocardiogram post-procedure showed a 1.5×1.8 cm mobile mass in the region of the mid atrial septum of the left atrium (figure 1E). This was confirmed with cardiac MRI (figure 1F). He was referred to the local cardiothoracic centre. Myxoma is the most common cardiac tumour and constitutes 50% of all benign cardiac tumours in adults, 75% of which are found in the left atrium.1 2 The most common presentation is one of the mitral valve obstruction which occurs in roughly 20–67% of cases, followed by embolic manifestations in approximately 20–50% of cases.1 3 4 Most cases of myxoma associated embolism result in cerebral emboli with stroke whereas embolism causing myocardial infarction are far less common at somewhere around 3–5%.4 5 The mainstay of treatment for myxoma is surgical resection, in cases where there is a high risk of embolism, surgery is recommended as soon as possible. Embolism accounts for approximately 4% of acute myocardial infarction, causes of which include AF, intra-cardiac tumours, malignancy, thrombophilia and endocarditis.6 This case highlights the importance of considering embolism in patients presenting with myocardial infarction, especially if there is little or no evidence of coronary artery disease. Consent obtained directly from patient(s).