zaki
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A 32-year-old woman is hospitalized for a left hemisphere transient ischemic attack. She has been asymptomatic except for mild exertional dyspnea. On physical examination the pulse rate is 84/min and regular, the blood pressure is 120/80 mm Hg, and the neck veins and lungs are normal. Cardiac examination reveals a high-pitched opening snap at the cardiac apex and a 2/6 mid-diastolic rumble. The chest radiograph is normal. The electrocardiogram shows only left atrial enlargement. Two-dimensional echocardiography indicates a sessile pedunculated mass in the left atrium, with mild mitral valve stenosis and mild mitral regurgitation by Doppler examination.
Which of the following should be the next step?
(A) Radionuclide imaging
(B) Right- and left-heart catheterization
(C) Initiation of heparin therapy
(D) Serial blood cultures
(E) Immediate cardiac surgery
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| alice8
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is it atrial myxoma :?: and the treatment would be E)Immediate cardiac surgery :?:
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| zaki
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you got it
right immediate cardiac surgery is reqd the dx is atreal myxoma
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| zaki
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sorry its atrial myxoma not atreal typing mistake
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| maratgr
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can you please tell me where you get these questions from. the patient is obviously embolizing to the brain from the heart. Pt will need surgery for his atrial myxoma but he should be anticoagulated first.
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| zaki
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The diagnosis of atrial myxoma is established by physical examination and confirmed by the echocardiogram. The opening snap is a tumor plop, and mitral regurgitation and stenosis result from the pedunculated tumor interfering with mitral leaflet motion during the cardiac cycle. Tumor emboli likely are responsible for the transient ischemic episode. Two-dimensional echocardiography can differentiate the characteristic images of left atrial myxoma from those of mitral valve vegetations. The treatment of choice to prevent further tumor embolization is removal of the tumor from the left atrium.
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