SHM Converge Scientific Abstract ePoster Gallery-A Hidden Culprit: The Lifesaving Potential of Tte in New-Onset Atrial Fibrillation

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This case report describes a 65-year-old man hospitalized for COPD exacerbation who was found to have new-onset atrial fibrillation. In accordance with 2023 ACC guidelines, a transthoracic echocardiogram (TTE) was obtained and unexpectedly revealed a large, highly mobile left atrial mass measuring 6.8 × 3.5 cm. The mass was prolapsing into the mitral valve orifice, causing moderate-to-severe mitral stenosis and raising concern for significant obstruction and embolic risk.<br /><br />A subsequent transesophageal echocardiogram (TEE) confirmed a gelatinous left atrial myxoma with a stalk near the coronary sinus. Because of the tumor’s size and mobility, urgent surgical removal was recommended. The patient underwent successful sternotomy with cardiopulmonary bypass, excision of a 5 × 6 cm left atrial myxoma, patch repair of the atrial defect, bi-atrial Maze ablation, and left atrial appendage clipping. He recovered without complications and was discharged on postoperative day 4.<br /><br />The report emphasizes the importance of routine TTE in newly detected atrial fibrillation, even when a clear trigger such as COPD exacerbation appears to explain the arrhythmia. Structural heart disease, including rare but potentially dangerous tumors like atrial myxoma, can otherwise be missed. In this case, echocardiography likely prevented a serious embolic or hemodynamic event by enabling early diagnosis and prompt surgery.<br /><br />Overall, the authors highlight that TTE is not only guideline-recommended but potentially lifesaving in patients with new-onset atrial fibrillation, particularly in those with COPD, where atrial fibrillation is common during exacerbations.

Asset Subtitle

Majed Sheikh

Meta Tag

Author List Abdallah Masri, Aleena Khan, Aravinth Krishnamoorthy, Danny Aiti, Lewis Humble, Majed Sheikh, Smriti Madaan, Varsha Konyala

Category Clinical Vignettes

Concept Transthoracic Echocardiography

Concept Atrial Fibrillation

Concept Atrial Myxoma

Concept Structural Heart Disease

Concept Left Atrial Mass

Distinguished Non-Finalist

Presenter Organization Canton Medical Education Foundation

Presenting Author Majed Sheikh

Track Adult

Keywords

COPD exacerbation

new-onset atrial fibrillation

transthoracic echocardiogram

transesophageal echocardiogram

left atrial myxoma

mitral stenosis

cardiac tumor

embolic risk

surgical excision

Maze ablation

Transthoracic Echocardiography

Atrial Fibrillation

Atrial Myxoma

Structural Heart Disease

Left Atrial Mass