title: Progressive wheeze: atrial myxoma masquerading as chronic obstructive pulmonary disease.
abstract: Atrial myxoma, the commonest primary cardiac neoplasm, presents with symptoms of heart failure, embolic phenomena or constitutional upset. We present an atypical case, with wheeze and symptomatic exacerbations typical of chronic obstructive pulmonary disease. With no early clinical evidence of heart failure, the patient was managed with inhaled steroids and bronchodilators, with little relief. Only when the patient was in extremis requiring intubation, due to respiratory failure, did clinical evidence of left heart failure become apparent, with echocardiography demonstrating a massive left atrial myxoma obstructing the mitral valve annulus. Following successful surgical resection, the patient's symptoms fully abated. This case highlights the importance of considering cardiac wheeze in those initially managed as obstructive airway disease not responding in a typical fashion to initial bronchodilator therapy, and particularly in those with rapidly progressive symptoms. Such patients should be referred early for cardiac imaging. The excellent prognosis and quick recovery after timely surgical resection of a myxoma are also highlighted.
authors.affiliation: Department of Cardiology, Buckinghamshire Healthcare NHS Trust, High Wycombe, UK.
authors.forename: Aish
authors.initials: A
authors.lastname: Sinha
authors.affiliation: Department of Cardiology, Buckinghamshire Healthcare NHS Trust, High Wycombe, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Apps
authors.affiliation: Department of Radiology, Buckinghamshire Healthcare NHS Trust, High Wycombe, UK.
authors.forename: Wei Chuen
authors.initials: WC
authors.lastname: Liong
authors.affiliation: Department of Cardiology, Buckinghamshire Healthcare NHS Trust, High Wycombe, UK.
authors.forename: Soroosh
authors.initials: S
authors.lastname: Firoozan
mesh_terms: D001993:Bronchodilator Agents / Q000627:therapeutic use; D004452:Echocardiography; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging*; D006333:Heart Failure / Q000209:etiology* / Q000628:therapy; D006338:Heart Neoplasms / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D008875:Middle Aged; D009232:Myxoma / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy / Q000209:etiology*; D013256:Steroids / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D001993:Bronchodilator Agents; D013256:Steroids