The Heart Had More to Reveal: Left Atrial Myxoma With Concomitant Coronary Artery Disease in a Hispanic Woman

Primary cardiac tumors are rare, with cardiac myxomas representing the most common benign primary cardiac neoplasm.Although surgical excision is definitive, comprehensive evaluation is essential to characterize the mass and identify concomitant cardiovascular disease that may alter management.We present an 86-year-old woman with hypertension, type 2 diabetes mellitus, hypothyroidism, and a 10-packyear smoking history who was referred after transthoracic echocardiography (TTE) identified a left atrial mass concerning for myxoma versus thrombus.She reported intermittent exertional chest tightness.A prior echocardiogram in 2023 demonstrated preserved left ventricular ejection fraction (LVEF) >55% without significant structural heart disease.Current TTE showed a mildly dilated left ventricle, mild concentric hypertrophy, global hypokinesis, LVEF 40%-45%, and a left atrial mass attached to the interatrial septum.Transesophageal echocardiography further characterized the lesion as a mobile, irregular mass arising from the interatrial septum, consistent with a left atrial myxoma, without mitral inflow obstruction.Given her age, cardiovascular risk factors, exertional symptoms, and anticipated cardiac surgery, coronary angiography was performed and revealed 70%-80% stenosis of the mid-left anterior descending artery (LAD), with preserved LV systolic function.The patient underwent resection of the left atrial mass with septal repair and concomitant coronary artery bypass grafting using the left internal mammary artery to the LAD.Histopathology confirmed cardiac myxoma.Postoperatively, temporary epicardial pacing was required.After pacing was discontinued, she developed symptomatic junctional bradycardia at <40 beats/min associated with dizziness, nausea, and malaise.Persistent symptomatic bradyarrhythmia ultimately required permanent dual-chamber pacemaker implantation.This case highlights the complexity of managing cardiac myxoma in an elderly patient with concomitant coronary artery disease.Multimodality imaging established the diagnosis and defined tumor anatomy, while preoperative coronary evaluation identified significant LAD disease and enabled simultaneous tumor resection and revascularization.Close postoperative rhythm surveillance is also essential, as clinically significant bradyarrhythmias may require permanent pacing.A multidisciplinary approach is critical to individualizing management of these rare cardiac tumors.