SHM Converge Scientific Abstract ePoster Gallery-Transient St Elvevations in the Setting of Cardiac Mxyoma

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This case describes a 50-year-old woman with migraines treated with triptans who presented with 1 day of chest pain and inferior ST elevations, prompting a STEMI activation. Her symptoms included chest pressure radiating to the right arm, but her troponin was only minimally elevated and coronary catheterization showed patent coronary arteries, arguing against acute coronary syndrome.<br /><br />Bedside echocardiography revealed a large left atrial mass. Formal transthoracic echocardiography demonstrated a mobile spherical mass attached to the atrial septum, and cardiac MRI confirmed a heterogeneously enhancing hypervascular mass measuring approximately 5.5 x 3.8 x 4.3 cm, consistent with a left atrial myxoma. She underwent successful surgical resection with septal reconstruction using a bovine pericardial patch.<br /><br />The authors propose that the transient ST elevations may have resulted from a small coronary embolus caused by the myxoma. Another possible contributor was coronary vasospasm, especially given her long-term triptan use for migraines. This case highlights that atrial myxomas can mimic myocardial infarction or transient ischemic symptoms, even when coronary arteries are normal.<br /><br />The main takeaway is that clinicians should include atrial myxoma in the differential diagnosis for chest pain with transient ST elevations, particularly when catheterization does not show coronary occlusion. Bedside transthoracic echocardiography is a useful initial screening tool, with formal echocardiography and cardiac MRI helping to confirm the diagnosis.

Asset Subtitle

Shannon E. Heffernan

Meta Tag

Author List Shannon E. Heffernan

Category Clinical Vignettes

Concept Atrial Myxoma

Concept ST Elevation

Concept Transthoracic Echocardiography

Concept Chest Pain

Concept Myocardial Infarction

Distinguished Non-Finalist

Presenter Organization University of Wisconsin Hospitals and Clinics

Presenting Author Shannon E. Heffernan

Track Adult

Keywords

atrial myxoma

ST elevation

chest pain

coronary embolus

coronary vasospasm

triptans

migraines

echocardiography

cardiac MRI

left atrial mass

Atrial Myxoma

ST Elevation

Transthoracic Echocardiography

Chest Pain

Myocardial Infarction