ST-elevation myocardial infarction from left atrial myxoma embolization: A case report

Abstract Background Cardiac myxomas are the most common primary tumours of the heart. Left atrial myxomas can present with systemic embolic manifestations. We describe a case of a left atrial myxoma that presented as ST-elevation myocardial infarction presumed to be caused by embolism to the left circumflex artery. Case summary A 52-year-old woman with no prior comorbidities presented with sudden-onset chest pain and dizziness. Electrocardiogram revealed ST-segment elevation in leads II,III, and aVF. Echocardiogram showed hypokinesia of the basal and mid inferior wall. Additionally, a large, mobile left atrial mass attached to the interatrial septum, prolapsing into the mitral inflow. The patient was transferred to the catheterisation laboratory for coronary angiogram. Angiogram showed an occluded distal obtuse marginal branch. There was no evidence of atherosclerosis in the rest of the coronary vasculature. Given high suspicion of embolic occlusion, the patient underwent emergency resection of the left atrial mass on day 3. The resected specimen was filled with gelatinous material and had a smooth surface.Histopathological examination confirmed diagnosis of myxoma. Discussion Our case illustrates a rare presentation of left atrial myxoma, with coronary artery occlusion highly suspected to have resulted from embolism of myxomatous material. A high index of suspicion and echocardiographic evaluation are needed to elucidate the cause of myocardial infarction, which would help select the appropriate reperfusion strategy.