HYPERTROPHIC CARDIOMYOPATHY ASSOCIATED WITH LEFT ATRIAL MYXOMA

In this paper we describe hypertrophic cardiomyopathy associated with left atrial myxoma. A 63 yr old patient presented with chest pain and dyspnea. There was no history of hypertension or syncope. Examination revealed a mid diastolic murmur at the apex which varied with patient position. His blood pressure was within normal limit. ECG revealed sinus rhytm and heart rate of 62 bpm. There was left ventricular hypertrophy by voltage criteria with negative T waves in the left precordial leads. Echocardiogram showed a mass of size 3.27 by 1.95 cm attached to the atrial septum by a narrow stalk which protruded through the mitral valve during diastole. Asymmetrical septal hypertrophy was noted. Interventricular septal thickness was 2.06 cm. LV posterior wall thickness was 1.23 cm. Systolic anterior motion of mitral valve was present. No significant LVOT gradient was noted. CT coronary angiogram showed normal epicardial coronary arteries. CT showed Left atrial myxoma as a filling defect in Left atrium. Banana shaped Left ventricular cavity was also made out suggesting HCM. The patient underwent surgery to remove left atrial myxoma. Histology of the biopsy specimen confirmed myxoma. Biopsy specimen of the LV wall showed hypertrophy and disarray of myocardial muscle cells. HCM has been associated with lentiginosis. Association of lentiginosis and left atrial myxoma has been described. We could find only one literature describing an association of hypertrophic cardiomyopathy with left atrial myxoma. This is the second case description of a patient with hypertrophic cardiomyopathy associated with a left atrial myxoma. The coexistence may be more than a chance occurrence so that the association of left atrial myxoma should be sought for when one sees a patient with a hypertrophic cardiomyopathy