Combination of Takotsubo cardiomyopathy with cardiac myxoma: a case report

Introduction. In the Russian literature, we have not found data on the combination of takotsubo syndrome (TTS) and left atrial (LA) myxoma. The work analyzed our own clinical case. TTS is diagnosed in 1,0-2,5% of patients hospitalized with suspected acute coronary syndrome (ACS). Primary cardiac tumors occur in cardiology with a frequency of up to 0,2%. The most common of them are LA myxoma.

Brief description. The patient was admitted to the clinic with suspected ACS. During the diagnostic search, both ACS and acute myocarditis were ruled out. An incidental finding during an echocardiographic study was LA myxoma.

Discussion. Due to a stressful situation, the patient developed symptoms similar to myocardial infarction. Based on coronary angiography data (normal coronary arteries, rapid restoration of myocardial contractility, no characteristic myocardial changes, myocardial infarction and acute myocarditis were excluded and TTS was established. LA myxoma was an unexpected finding.

Myxoma may contribute to TTS, presumably through central mechanisms regulating the activity of the cardiovascular system. Also important is the systemic inflammation caused by myxoma, which reduces the threshold for the development of Takotsubo cardiomyopathy in response to stress factors.

1. Wan S-H, Liang JL. Takotsubo cardiomyopathy: etiology, diagnosis, and optimal management. Research Reports in Clinical Cardiology. 2014;5:297-303. doi:10.2147/RRCC.S46021.

2. Sergeeva VA, Tolstov SN, Sychkova ED. Clinical Observation of Asymptomatic Left Atrial Myxoma. The Russian Archives of Internal Medicine. 2022;12(5):389-93. (In Russ.) doi:10.20514/2226-6704-2022-12-5-389-393.

3. Fomin VV, Kogan EA, Morozova NS, et al. Сardiac myxoma: challenge in diagnostics. Case report. Terapevticheskii Arkhiv. 2021;93(4):470-7. (In Russ.) doi:10.26442/00403660.2021.4.200685.

4. Okan T, Babliak O, Agarwal K, et al. Asymptomatic Left Atrial Myxoma Treated with Minimally Invasive Surgical Approach. Cureus. 2021;13:10-e18432. doi:10.7759/cureus.18432.

5. Dinesh Kumar US, Wali M, Shetty SP, Sujay KR. Left atrial myxoma — a tumor in transit. Ann Card Anaesth. 2019;22:4:432-4. doi:10.4103/aca.ACA_232_18.

6. Yalta K, Ozkan U, Yalta T, et al. Cardiac myxoma as a potential trigger of Takotsubo cardiomyopathy: a brief review on mechanistic and clinical perspectives. Monaldi Arch Chest Dis. 2021. doi:10.4081/monaldi.2021.1961.

7. Ishibashi N, Nagai M, Dote K, et al. A variant of Takotsubo syndrome concomitant with left atrial myxoma. Clin Case Rep. 2022;10:e05529. doi:10.1002/ccr3.5529.

8. Nagai M, Hoshide S, Kario K. The insular cortex and cardiovascular system: a new insight into the brain-heart axis. J Am Soc Hypertens. 2010;4:174-82. doi:10.1016/j.jash.2010.05.001.

9. Nagai M, Kishi K, Kato S. Insular cortex and neuropsychiatric disorders: a review of recent literature. Eur Psychiatry. 2007;22:387-94. doi:10.1016/j.eurpsy.2007.02.006.

10. Kaktursky LV, Mikhaleva LM, Mishnev OD, et al. Takotsubo syndrome (stress-induced cardiomyopathy). Pathology archive. 2021;83(1):5-11. (In Russ.) doi:10.17116/patol2021830115.

11. Alexander RL, Rodolfo C, Birke S, et al. Pathophysiology of Takotsubo Syndrome: JACC State-of-the-Art Review. J Am Coll Cardiol. 2021;77:902-21. doi:10.1016/j.jacc.2020.10.060.

12. Boldueva SA, Evdokimov DS. Takotsubo cardiomyopathy. Review of literature data: concept, epidemiology, pathogenesis. Part I. Russian Journal of Cardiology. 2022;27(3S):4993. (In Russ.) doi:10.15829/1560-4071-2022-4993.