16/08/2026
HEART TUMORS AND HEART FAILURE AND STROKE SYNDROMES
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Beauti of of rapid excess heart failure clinic ( RAHFC)
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This novel clinic is a part of multidisciplinary heart failure programe and CCPC heart failure.
On this clinic patients are seen on same day without appointment ,this clinic is not for known compensated heart failure patients but , only for new onset
de novo ( HF with in month ) heart failure with mild to moderate heart failure symptoms ( like breathless on exertion , paraoxysmal at night PND , cant sleep after midnight because of worseing cough and breathlessness ,fatigue and ankle edema ) .patients with mild to moderate symptoms usually go to family physicians , pulmonologists or general physicians, most of these patients are treated as COPD of infections if partially improve symptoms usually go without pro BNP and echocardiogram indeed .untill echo is done and if LV dysfunction or structural heart defect then only referred to general or heart failure cardiologists ,some by the time reach to advanced heart center or specialised clinic,unfortunately become late or inoperable/ high risk for surgical intervention.
Patients with sever symptoms usually go to emergency and if not admitted then are referred to RAHFC.
This clinic agenda is Same day work up if heart failure is confirmed , we start GDMT on same day if etiology is not yet established on routine work up, we book them for TEE / CMRI ( IF INDICATED ) or admit them for CAG ,if probability of CAD is high.
if basic work up is normal ( EKG,ECHO,PRO BNP and other routine biochemical tests) ,we dispose such patients back to referring physician on same day for further work up if indicated or controll of atherothrombotic risk factors with feed back letter in detail. ( Stage A and B heart failure ) .
INTRESTING CASE PRESENTATION.
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48 year female mother of 3 children's, diabetic for 5 years non smoker .uneventful deliveries .Referred by family physician for exertional breathlessness FC II no angina no PND FOR 3 to 4 weeks with non specific T wave changes on EKG . I evaluated at RAHFC, PSCCH al hassa on 21 January 2018 .
physical examinamination was essentially unremarkable except short diastolic murmur at apex in left lateral position.I suspected for mitral stenosis so sent her for echo , after a while technician call me to see this huge elephant in the heart .so there was large left Atrial myxoma .Surgical colleague was consulted and was admitted in hospital .TEE Echo was done for better visualization of tumor .being above 40 and diabetic coronary angiogram was done which revealed normal coronaries.
Next day she was operated ,remain uncomplicated.biopsy showed myxoma and was discharged home.( Thanks to echo and surgical colleagues )
DISCUSSION
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There are two types of heart tumors primary and secondary tumors of heart.
primary tumors are extremely rare ,5 % to 10% only .
Atrial myxomas are most common 80% and 75% are in Left atrium .
Myxomas are higher in women than men 3: 1 ratio, usually seen in 30 to 60 years age group.
Incidence of cardiac myxoma is about 0.5 % per million per year.
Location wise 75% to 80% in left atrium ,10 % to 20% in right atrium .5% to 10% in both atria or atrium and ventricle.( luckily I have seen all varieties).
Myoxomas are morphologically solid tumors attached to interatrial septum globular or multilobular if large can protrude through mitral valve and cause obstruction. ( Main cause of strokes and sudden cardiac death ).
CLINICAL SYMPTOMS and 3 main presentations
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