HYPERTROPHIC CARDIOMYOPATHY ASSOCIATED WITH LEFT ATRIAL MYXOMA

Abstract

In this paper we describe hypertrophic
cardiomyopathy associated with left atrial
myxoma. A 63 yr old patient presented
with chest pain and dyspnea. There was
no history of hypertension or syncope.
Examination revealed a mid diastolic
murmur at the apex which varied with
patient position. His blood pressure was
within normal limit. ECG revealed sinus
rhytm and heart rate of 62 bpm. There
was left ventricular hypertrophy by voltage
criteria with negative T waves in the
left precordial leads. Echocardiogram
showed a mass of size 3.27 by 1.95 cm
attached to the atrial septum by a narrow
stalk which protruded through the mitral
valve during diastole. Asymmetrical septal
hypertrophy was noted. Interventricular
septal thickness was 2.06 cm. LV
posterior wall thickness was 1.23 cm.
Systolic anterior motion of mitral valve
was present. No significant LVOT gradient
was noted. CT coronary angiogram
showed normal epicardial coronary
arteries. CT showed Left atrial myxoma as
a filling defect in Left atrium. Banana
shaped Left ventricular cavity was also
made out suggesting HCM. The patient underwent
surgery to remove left atrial
myxoma. Histology of the biopsy specimen
confirmed myxoma. Biopsy specimen of
the LV wall showed hypertrophy and disarray
of myocardial muscle cells. HCM has
been associated with lentiginosis. Association
of lentiginosis and left atrial myxoma
has been described. We could find only
one literature describing an association of
hypertrophic cardiomyopathy with left atrial
myxoma. This is the second case description
of a patient with hypertrophic cardiomyopathy
associated with a left atrial
myxoma. The coexistence may be more
than a chance occurrence so that the association
of left atrial myxoma should be
sought for when one sees a patient with a
hypertrophic cardiomyopathy.