[Coronary embolism from atrial myxoma: a rare cause of myocardial infarction? Case report and literature review].

Abstract

A 44-year-old man with no known cardiovascular history or risk factors experienced chest pain after a volleyball match. ECG showed ST-segment elevation in the inferior leads, a finding consistent with ST-elevation myocardial infarction (STEMI). The patient was urgently taken to the cath lab, where coronary angiography revealed complete occlusion of the distal left anterior descending artery and of an obtuse marginal branch. Plain old balloon angioplasty was attempted but unsuccessful. During the procedure, an abnormal vascular network originating from the right coronary artery and the circumflex artery and directed toward the left atrium was observed. Transthoracic echocardiography revealed a 30 x 32 mm ovoid, pedunculated mass attached to the atrial roof. Transesophageal echocardiography confirmed the finding, very suggestive of an atrial myxoma. Upon deeper anamnesis, the patient reported transient episodes of visual loss. Brain magnetic resonance imaging revealed multiple small gliotic lesions, indicative of systemic embolization. The patient underwent surgical resection of the mass via right mini-thoracotomy. Histological analysis confirmed the diagnosis of atrial myxoma. This case highlights the importance of considering an embolic etiology in STEMI, especially in young patients without traditional cardiovascular risk factors.