Eftekharzadeh Pejmahn, Ahmed Shahzad
Internal Medicine, Lower Bucks Hospital, Bristol, USA.
Cardiology, Lower Bucks Hospital, Bristol, USA.
Cureus. 2021 Oct 29;13(10):e19116. doi: 10.7759/cureus.19116. eCollection 2021 Oct.
The size and location of cardiac tumors determine how patients present with signs of heart failure due to diminished cardiac output within the circulatory system. Poor cardiac output presents with signs of heart failure, which include pulmonary edema, lower extremity edema, jugular venous distention, dyspnea, orthopnea and can be insidious in onset. Vital signs on presentation can often be abnormal and patients may present hemodynamically unstable. We present a case of a female who presented to the emergency room after experiencing a sudden onset of substernal, pressure-like chest pain while sleeping. Vital signs on presentation were stable with no evidence of heart failure symptoms as listed above. Cardiac catheterization showed patent coronary arteries but was found to have a 5.8 x 4.7 x 3.5 cm hypervascular cardiac myxoma located in the right atrium. Instead of a typical heart failure presentation, as any space-occupying mass would decrease the effective cardiac output, the patient presented with angina. During the procedure, the mass was noted to be perfused by the left circumflex artery, creating coronary steal phenomenon, shifting blood away from the coronary arteries and into the mass, causing ischemic anginal pain. The patient ultimately underwent surgical excision of the lesion and her anginal symptoms resolved.
心脏肿瘤的大小和位置决定了患者因循环系统心输出量减少而出现心力衰竭症状的表现方式。心输出量降低会出现心力衰竭症状，包括肺水肿、下肢水肿、颈静脉怒张、呼吸困难、端坐呼吸，且起病可能隐匿。就诊时的生命体征通常会异常，患者可能表现为血流动力学不稳定。我们报告一例女性患者，她在睡觉时突然出现胸骨后压榨样胸痛后到急诊室就诊。就诊时生命体征稳定，无上述心力衰竭症状。心脏导管检查显示冠状动脉通畅，但发现右心房有一个5.8×4.7×3.5厘米的高血管性心脏黏液瘤。与任何占位性肿块都会降低有效心输出量的典型心力衰竭表现不同，该患者表现为心绞痛。在手术过程中，发现肿块由左旋支动脉供血，产生冠状动脉窃血现象，使血液从冠状动脉转移到肿块，导致缺血性心绞痛。患者最终接受了病变的手术切除，心绞痛症状得以缓解。
