myxoma is the most common benign cardiac primary tumors , accounting about 50% of cardiac tumors and is more prevalent among females . because of different size of myxomas and their location in the different chambers of heart , patients with atrial myxoma usually present with cardiovascular symptoms such as heart failure and pulmonary hypertension , secondary to mitral valve obstruction .
constitutional symptoms of atrial myxoma include weight loss , fatigue , fever , clubbing , anemia , orthopnea , and acute pulmonary edema . on the other hand , myxomas may cause life - threatening cardiac symptoms , e.g. , syncope , requiring emergency surgery .
two - dimensional echocardiography is the primary diagnostic imaging , not only as a complement to conventional echocardiography in the assessment of left atrial myxomas but also as a method of differentiating such masses from extra - cardiac tumors compressing the atrium .
echocardiography is a helpful method that can determine the tumor size , shape , and mobility . here
she dropped during the second prostration in prayer and decreased her mental state , with no prior history of syncope , shortness of breath , or chest pain .
she had no significant past medical history , but she had a positive family history of early cardiovascular disease . at presentation , the patient was afebrile and had normal vital signs ( heart rate 80 bpm , blood pressure 110/70 mmhg , oxygen saturation 97% while breathing room air ) and jugular venous pressure ( jvp ) was normal .
a 12-lead electrocardiogram revealed normal sinus rhythm with nonspecific minor st - t abnormalities . on cardiac examination ,
a transthoracic echocardiogram ( tte ) was performed which showed the presence of a pediculated mass in the left atrium , with an appearance suggestive of atrial myxoma , that was prolapsed through the mitral valve towards the left ventricle by changing patient 's position [ figure 1a  c ] .
( a - c ) transthoracic echocardiography : chambers view showing a large mobile left atrial mass prolapsing through mitral valve the patient was referred for urgent surgery .
she recovered without major complication and was discharged . at 2-year follow - up , she remains with excellent cardiac function .
myxoma is the most common primary benign cardiac tumor . despite the fact that they can be discovered unexpectedly in asymptomatic patients , myxomas usually present with nonspecific signs and symptoms .
depending on myxomas locations and their association with the heart structures , they can provide symptoms .
tumors that origins from the left atrium , especially if mobile and large , may result in symptoms similar to mitral stenosis due to obstruction of atrio - ventricular blood flow .
these symptoms include : exertional dyspnea , paroxysmal nocturnal dyspnea , orthopnea , fatigue , and syncope . in our patient ,
the tumor plop of myxoma is a protodiastolic murmur that is heard 80 to 150  ms after s2 .
tumor plop may be mistaken for an opening snap , and tumor obstruction of the valve leads to a diastolic murmur .
the central nervous system ( cns ) symptoms usually call for computed tomography ( ct ) or magnetic resonance imaging ( mri ) scan of the brain to exclude embolization or an aneurysm formation , which is sometimes associated with myxomas .
it has been suggested as prudent to perform mri scan of the brain in all cardiac myxoma cases to exclude central nervous system ( cns ) manifestations . in our patient ,
transthoracic echocardiography reported a mobile and pedunculated mass in the left atrium , which was attached to the interatrial septum .
the mass prolapsed into the left ventricle across the mitral valve , resulting in a mitral valve obstruction . recently
, the diagnosis of cardiac tumors has improved enormously , and echocardiography has become a choice screening tool for cardiac tumors .
the location of the myxoma in the left atrium and its origination from the atrial septum are chief clues for the diagnosis .
thus , it is very important to recognize the location of the tumor during echocardiography . as reported in other studies ,
tte is usually sufficient to make the diagnosis , but if the results are suboptimal , transesophageal echocardiogram ( tee ) should be employed . in conclusion , echocardiography is likely to be a valuable diagnostic tool in patients who have had a cardiac mass . besides , it also offers the cardiologist and cardiovascular surgeon the chance of more accurate pre- and intra - operative assessment of cardiac masses .
 cardiac myxoma is the most frequent benign tumors of heart . 
 a 37-year - old woman dropped during the second prostration in prayer and decreased his mental state , with no prior history of syncope . on cardiac examination 
 , there was an early diastolic sound that was compatible with a tumor plop . 
 a transthoracic echocardiogram was performed which showed the presence of a pediculated mass in the left atrium , with an appearance suggestive of atrial myxoma . 
 atrial myxoma can appear with non - specific symptoms . 
 the best diagnostic method for myxoma is echocardiography that has a high sensitivity 
INTRODUCTION
CASE REPORT
DISCUSSION