Clinical presentation and investigation findings in cardiac myxomas: new insights from the developing world

Background Cardiac myxomas are an uncommon condition and most of the available information on their clinical features comes from smaller series of patients from developed countries. Our aim was to quantify and correlate the clinical and investigation findings in cardiac myxomas in a developing country and compare them with existing data. Methods A retrospective study of case notes, electrocardiograms, and x-rays of 171 patients treated for cardiac myxoma from February 1992 to October 2006 at a large charitable institution in South India was conducted. Frequency of different clinical findings and relationships between these findings, age, sex, tumor location, and size were calculated. Results The mean age at presentation was 37.1 years. Dyspnea was the most common symptom. Embolism was found in 9% of patients and systemic symptoms in 20% of patients. Auscultation abnormalities were present in 89% of patients, including a tumor plop in 50%. Left atrial enlargement was the most common electrocardiographic abnormality (35%), whereas cardiomegaly was the most common chest x-ray finding (55%). Raised erythrocyte sedimentation rate was found in 75% and anemia in 45% of patients. Female patients and patients with right atrial myxomas more commonly had systemic symptoms. Tumor size correlated with electrocardiographic and x-ray abnormalities. Conclusions Cardiac myxomas present at a younger age in developing countries. Almost all patients were symptomatic because they presented for medical care at an advanced stage of disease. Certain clinical manifestations depend on site and size of the tumor as well as age of the patient. A high index of suspicion is necessary for making an early diagnosis.