A Mysterious Fall Was the First Sign Something Was Wrong

Myxomas are rare. In autopsy studies, around 100 myxomas are seen per one million population. For reasons that are not well understood, they are more common in women than in men. Size at the time of diagnosis can be variable. Most are ovoid, and they can range from as small as a pea to the size of a large grapefruit. These tumors are often found accidentally, as in this case, in ultrasounds ordered to look for something else. But they can cause symptoms and, rarely, even death.

To understand the harm, it is important to know the anatomy, Minella explained. The heart is divided into four chambers — the right side of the heart receives the oxygen-poor blood from the rest of the body. When the heart beats, the blood in the right side is squeezed into the lungs, where it is reloaded with oxygen. When the heart relaxes, that newly oxygenated blood flows into the left side of the heart. Both sides are divided into two parts: the atrium, a thin walled chamber that receives the blood, and the more muscular ventricle, which pushes the blood to its next stop, either the lungs (from the right side) or the rest of the body (from the left side). These tumors can have tiny clots on their surface. If the mass is on the left side of the heart — where most are — a loosened clot could travel to the brain and cause a stroke. If on the right side, where this patient’s mass was seen, the clot would travel to the lung, cutting off blood flow there.

Less common but more concerning was the possibility of obstruction within the heart. When the heart squeezed with each beat, the mass would be pushed toward the valve that separates the atrium from the ventricle. If it somehow blocked that opening, no blood would be able to get through. That was probably what happened to her in the beauty parlor, Minella explained. That episode was most likely caused by this sudden loss of blood flow to the brain. And when she stumbled, she jostled the mass out of the valve, and the blood flow resumed. The myxoma looked as if it was just the right size to block that opening. She was lucky it hadn’t happened more often.

The tumor would have to be removed as soon as possible, Minella told the patient and her husband. The risk was small but real. The surgery took place three days later. The surgeon had to cut her chest wide open from neck to the bottom of her sternum. Only then could he safely remove the tumor.

Once the woman was home, her friend Sandi came by to see her. Sandi had been worried since the woman first described what the ultrasound showed. When Sandi got home from the funeral, she read up on those tumors. That’s why she called Minella’s office that afternoon. She wanted to make sure that the next funeral she went to wasn’t her friend’s.

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