Silva Rodrigo Rufino Pereira, Magalhães Carolina Jerônimo, Silva Rafael Silvestre Vieira da, Rocha Giulia Antoni Ferreira, Cavalcanti Paulo Ernando Ferraz, Montenegro Sérgio Tavares
Pronto Socorro Cardiológico de Pernambuco Professor Luiz Tavares (PROCAPE), Recife, PE - Brasil.
Universidade de Pernambuco (UPE), Recife, PE - Brasil.
Arq Bras Cardiol. 2024 Apr 22;121(3):e20230538. doi: 10.36660/abc.20230538. eCollection 2024.
Cardiac tumors are rare entities, among which atrial myxoma (AM) stands as the most frequent, accounting for approximately half of all reported cases. The incidence of AM is estimated to range from 0.001% to 0.3% within the general population, yet only about 0.06% of these cases present with coronary embolic events. We report on a 33-year-old male smoker who experienced acute, severe precordial pain radiating to the left upper limb, lasting for one hour. The electrocardiographic evaluation demonstrated ST-segment elevation in leads D2, D3, and aVF, alongside significantly elevated serum troponin levels, confirming a diagnosis of ST-segment elevation myocardial infarction (STEMI). Subsequent coronary angiography revealed proximal occlusion of the right coronary artery due to thrombus. An initial attempt of thrombus aspiration was unsuccessful, followed by primary angioplasty with balloon inflation without stent placement. Further diagnostic exploration through transthoracic echocardiography identified a homogenous, smooth-surfaced mass measuring 5.2 cm x 2.3 cm attached to the interatrial septum. This mass, characterized by lobulations, prolapsed into the mitral valve and left ventricle during diastole, consistent with AM. Surgical resection of the mass was successfully performed, with the patient being discharged asymptomatic. In the reported case, the patient's profile, notably his age, and gender, diverges from the typical epidemiological characteristics associated with AM. This case adds to the limited number of reports where the inferior wall is affected by the right coronary artery being occluded. This report emphasizes the significance of differential diagnoses in younger patients presenting with STEMI.
心脏肿瘤是罕见疾病，其中心房黏液瘤（AM）最为常见，约占所有报告病例的一半。据估计，普通人群中AM的发病率为0.001%至0.3%，但这些病例中只有约0.06%会出现冠状动脉栓塞事件。我们报告了一名33岁男性吸烟者，他经历了急性、严重的心前区疼痛，并向左上肢放射，持续了1小时。心电图评估显示D2、D3和aVF导联ST段抬高，同时血清肌钙蛋白水平显著升高，确诊为ST段抬高型心肌梗死（STEMI）。随后的冠状动脉造影显示右冠状动脉近端因血栓而闭塞。最初的血栓抽吸尝试未成功，随后进行了未放置支架的球囊扩张初级血管成形术。通过经胸超声心动图进一步诊断发现，一个大小为5.2 cm×2.3 cm的均匀、表面光滑的肿块附着于房间隔。该肿块有分叶，在舒张期脱垂入二尖瓣和左心室，符合AM。成功进行了肿块手术切除，患者出院时无症状。在报告的病例中，患者的特征，尤其是年龄和性别，与AM相关的典型流行病学特征不同。该病例增加了下壁受右冠状动脉闭塞影响的有限报告数量。本报告强调了对年轻STEMI患者进行鉴别诊断的重要性。
