Diagnostically Challenging Cardiac Myxoma Presenting as Acute Myocardial Infarction

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Acute myocardial infarction secondary to left atrial myxoma embolization (n=1). Intervention: Emergency surgical resection of left atrial myxoma.

Q: What does this research mean for the field?

Embolization of a left atrial myxoma into coronary arteries can manifest as acute myocardial infarction in young patients and can be effectively treated with emergency surgical resection. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Mathieu Castonguay; Mohammed Alyosif; Osama Essam ElKhateeb; Wan Kim; Claudia Côté

doi:10.1016/j.jaccas.2026.108575

July 22, 2026JACC Case ReportsOpen Access

Diagnostically Challenging Cardiac Myxoma Presenting as Acute Myocardial Infarction

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Key result

Emergency resection successfully treats acute MI caused by an embolizing left atrial myxoma.

n=1

Why the study?

Primary cardiac myxomas are rare and can present variably, including as acute myocardial infarction, posing diagnostic challenges.

Key Points

To describe an uncommon presentation of an embolizing left atrial myxoma manifesting as an acute myocardial infarction in a young female patient.
Evaluated a 31-year-old woman presenting with sudden chest pain and syncope using electrocardiography and laboratory biomarker assays.
Performed emergent coronary catheterization, left ventriculography, and transthoracic echocardiography to identify the etiology of myocardial ischemia.
Conducted emergency median sternotomy with bicaval cannulation and transseptal resection of the left atrial mass, followed by histopathological examination.
Initial electrocardiogram showed self-terminating ventricular tachycardia and inferior ST-segment elevation, while high-sensitivity troponin peaked at 2,066 ng/L.
Coronary angiography showed abrupt tapering of the left anterior descending artery, diagonal branches, and obtuse marginal branch mimicking type 2 spontaneous coronary artery dissection, alongside abnormal feeding microvessels off the mid-right coronary artery.
Echocardiography identified a 4 × 3 × 2 cm left atrial mass prolapsing across the mitral valve, and surgical pathology confirmed a 3.0 × 2.1 × 1.5 cm villiform cardiac myxoma with surface rupture and platelet-fibrin thrombi.

Study Design

Type

Case Report (n=1)

Structured PICO

P

Population

1 31-year-old woman presenting with acute ST-segment elevation myocardial infarction and self-terminating ventricular tachycardia secondary to an embolizing left atrial myxoma.

I

Intervention

Emergency surgical resection of the left atrial myxoma via median sternotomy with interatrial septum repair using autologous pericardium.

O

Outcome

Successful surgical resection and patient discharge.

This case highlights the importance of including left atrial myxoma embolization in the differential diagnosis of acute coronary syndrome in young female patients, especially when angiographic features mimic spontaneous coronary artery dissection.

Implication

Myxoma embolization merits consideration in young ACS without risk factors; extends sparse case reports but leaves open prospective validation.

Abstract

BACKGROUND: Primary cardiac tumors are rare. Among them, myxomas are the most common, and clinical presentations can be variable. CASE SUMMARY: A 31-year-old woman presented with sudden-onset chest pain and syncope. The electrocardiogram demonstrated self-terminating ventricular tachycardia and inferior ST-segment elevation. She was found to have a left atrial myxoma with embolization to the coronary arteries and underwent successful emergency resection. DISCUSSION: The diagnosis of stress cardiomyopathy was ruled out by echocardiography. Angiography did show an abrupt change in vessel diameter between normal and diseased segments, which suggested type 2 spontaneous coronary artery dissection. However, the abnormal left atrial feeding vessel suggested an embolic phenomenon from a cardiac tumor. TAKE-HOME MESSAGES: This case is an unusual presentation of an embolizing left atrial myxoma presenting as acute myocardial infarction in a young woman. This highlights the importance of including left atrial myxoma in the differential diagnosis of acute coronary syndrome in young female patients.

Discussion

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Cite This Study

Castonguay et al. (2026) conducted a case report in Acute myocardial infarction secondary to left atrial myxoma embolization (n=1). Emergency surgical resection of left atrial myxoma was evaluated. A young woman presenting with acute myocardial infarction was found to have an embolizing left atrial myxoma and underwent successful emergency surgical resection.

synapsesocial.com/papers/6ad0fc3a15427f6a84040018 https://doi.org/10.1016/j.jaccas.2026.108575

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Diagnostically Challenging Cardiac Myxoma Presenting as Acute Myocardial Infarction

Key Points

Study Design

Structured PICO

Implication

Abstract

Discussion

Cite This Study

Diagnostically Challenging Cardiac Myxoma Presenting as Acute Myocardial Infarction

Key Points

Study Design

Structured PICO

Implication

Abstract

Discussion

Cite This Study

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