Cardiac myxoma may seem like an uncommon medical term, but it is a type of tumor worth learning about, particularly because it develops inside the heart and may affect blood flow or cause different symptoms from one person to another. Although a cardiac myxoma is usually a benign, non-cancerous tumor, its location inside the heart means that it may require appropriate medical evaluation and treatment. In this guide from Dalili Medical, we will discuss the causes of cardiac myxoma, its symptoms and types, how it is diagnosed, treatment with medications, surgical removal options, and the most frequently asked questions about cardiac myxoma.

What Is Cardiac Myxoma?

Cardiac myxoma is a rare tumor that develops inside the chambers of the heart. In most cases, it occurs in the left atrium, particularly near the wall separating the two atria. Although a myxoma is usually a benign, non-cancerous tumor, its location inside the heart may affect blood flow, making appropriate medical evaluation important.

Is Cardiac Myxoma a Cancerous Tumor?

Usually, no. Most cardiac myxomas are benign and non-cancerous. However, their potential seriousness depends not only on whether they are benign but also on their location and size. A myxoma may obstruct blood flow through the heart or cause complications, such as the release of tumor fragments or the formation of blood clots in some cases.

Where Does Cardiac Myxoma Usually Occur?

Cardiac myxoma most commonly develops in the left atrium, usually attached to the wall separating the two atria. It can also occur in the right atrium, while tumors arising in the ventricles are less common.

Is Cardiac Myxoma Hereditary?

Most cases of cardiac myxoma are not associated with a clear hereditary cause and occur sporadically. However, the presence of multiple myxomas, recurrence after surgical removal, or development at a young age may lead a doctor to investigate the possibility of a genetic condition such as Carney complex.

Can Cardiac Myxoma Cause Shortness of Breath?

Yes. A myxoma may cause shortness of breath and fatigue if it obstructs blood flow through the heart. This may be more noticeable when the tumor is located in the left atrium near the mitral valve, and symptoms may become worse during physical activity.

Can Cardiac Myxoma Cause Dizziness or Fainting?

Yes. Cardiac myxoma may cause dizziness or fainting in some cases, particularly if its size or location obstructs blood flow through the heart or reduces the amount of blood reaching the body's organs. Recurrent or unexplained fainting should be medically evaluated to determine the underlying cause.

Can Cardiac Myxoma Cause Heart Palpitations?

Some people with myxoma may experience heart palpitations or a feeling of irregular heartbeats. However, palpitations can have many other causes, including stress and certain heart rhythm disorders. Therefore, experiencing palpitations alone does not necessarily indicate cardiac myxoma.

Can Cardiac Myxoma Cause a Blood Clot?

Yes, blood clots can occur in some cases of cardiac myxoma. Small pieces of the tumor may break away, or blood clots may form in association with the tumor and then travel through the bloodstream, potentially causing blockage of a blood vessel.

Can Cardiac Myxoma Cause a Stroke?

Yes. If a piece of the tumor or a blood clot associated with it travels to the blood vessels supplying the brain, it may cause a stroke or other neurological complications.

Therefore, if sudden symptoms such as weakness or numbness on one side of the body, difficulty speaking, sudden loss of balance, or sudden changes in vision occur, emergency medical care should be sought immediately.

How Is Cardiac Myxoma Diagnosed?

Diagnosis of cardiac myxoma begins with a medical history, assessment of symptoms, and a physical examination. The doctor may then request several tests to confirm the presence of the tumor and determine its location, size, and effect on heart function. These may include:

• Echocardiogram: One of the most important tests for detecting myxoma. It can help determine the tumor's location, size, mobility, and effect on blood flow.
• Electrocardiogram (ECG): May be used to assess the heart rhythm and identify associated electrical abnormalities.
• Cardiac CT scan: May be recommended in some cases to obtain additional information about the tumor and its location.
• Cardiac MRI: May help evaluate the nature of the mass and its relationship to surrounding tissues when more detailed imaging is needed.
• Additional tests: The doctor may order blood tests or other investigations depending on the symptoms, overall health, and possible complications.

Does Cardiac Myxoma Show Up on an ECG?

An electrocardiogram (ECG) may show some changes associated with the condition, but it is usually not sufficient to confirm the presence of a myxoma. Echocardiography is more important for detecting the tumor and determining its location, size, and effect on blood flow within the heart.

Does Cardiac Myxoma Require Open-Heart Surgery?

In many cases, cardiac myxoma is removed through conventional heart surgery, using a heart-lung bypass machine during the procedure. In selected cases, depending on the tumor’s size and location and the expertise of the medical center, minimally invasive, endoscopic, or robotic-assisted surgery may be possible.

The cardiac surgeon determines the most appropriate surgical approach after a comprehensive assessment of the tumor and the overall condition of the heart.

Can Cardiac Myxoma Come Back After Removal?

Yes, cardiac myxoma can recur after surgical removal, although recurrence is uncommon when the tumor has been completely removed. The risk may be higher in patients with a family history or certain genetic syndromes, such as Carney complex. For this reason, the doctor may recommend regular follow-up examinations after surgery.

Types of Cardiac Myxoma

Cardiac myxoma can be classified according to its location, number of tumors, certain structural characteristics, and, in some cases, its association with genetic syndromes.

First: Types of Myxoma According to Location

1. Left Atrial Myxoma

Left atrial myxoma is the most common type of cardiac myxoma. It usually develops near the septum separating the two atria and may extend toward or move near the mitral valve.

Depending on its size and movement, it may obstruct blood flow from the left atrium to the left ventricle, potentially causing:

• Shortness of breath.
• Fatigue and weakness.
• Dizziness or fainting.
• Heart palpitations.
• Symptoms resembling certain mitral valve disorders.

2. Right Atrial Myxoma

This type develops in the right atrium and is less common than left atrial myxoma.

It may interfere with blood returning to the heart. Symptoms vary depending on the tumor’s size and location and may include fatigue or signs of venous congestion in more advanced cases.

3. Ventricular Myxoma

Ventricular myxoma is uncommon compared with atrial myxomas. It may develop in:

• The left ventricle.
• The right ventricle.

Symptoms and complications depend on the tumor’s location and size and how much it affects blood flow or the heart valves.

4. Multifocal Myxoma

In rare cases, more than one myxoma may develop inside the heart, either within the same chamber or in different chambers.

This pattern is particularly important when there are signs suggesting Carney complex, a rare genetic condition that may be associated with multiple or recurrent cardiac myxomas.

---

Second: Types of Myxoma According to the Number of Tumors

1. Solitary Myxoma

This refers to the presence of a single myxoma inside the heart and is the most common presentation.

2. Multiple Myxomas

In this form, more than one myxoma is present and may occur in one heart chamber or several chambers.

Multiple tumors may require a more comprehensive evaluation, particularly when they occur at a young age, there is a family history, or the tumor has recurred after previous removal.

---

Third: Types of Myxoma According to Shape and Characteristics

Doctors may describe a myxoma according to its appearance, mobility, and point of attachment, based on echocardiography, advanced imaging, or findings during surgery.

1. Smooth-Surfaced Myxoma

This type has a relatively regular surface and may be relatively firm compared with some tumors that have irregular surfaces.

2. Irregular or Fragile Myxoma

The surface may be rough or irregular. Some fragile tumors may be more susceptible to fragmentation, which can, in certain cases, allow tumor fragments to travel through the bloodstream.

3. Mobile Myxoma

The tumor may be attached to the heart wall or the interatrial septum by a stalk or narrow attachment, allowing it to move with the heartbeat.

Mobility becomes particularly important when the tumor is close to a heart valve, as it may intermittently obstruct blood flow.

4. Broad-Based Myxoma

In some cases, the tumor has a broad attachment to the heart wall rather than being connected by a narrow stalk.

The size and location of this attachment may influence the surgical approach and whether the area from which the tumor arose needs to be repaired.

---

Fourth: Types of Myxoma According to Genetic Association

1. Myxoma Not Associated With a Genetic Syndrome

This is the most common form and usually occurs as an isolated tumor without a known family history or genetic syndrome.

2. Myxoma Associated With Carney Complex

Myxoma may occur as part of Carney complex, a rare genetic disorder that can be associated with multiple or recurrent cardiac myxomas.

This form may have features such as:

• Occurrence at a younger age.
• Multiple myxomas.
• A higher likelihood of recurrence after removal.
• Other signs or tumors associated with the syndrome.

Are There Cancerous Types of Cardiac Myxoma?

In most cases, cardiac myxoma is a benign tumor and is not cancerous. However, other cardiac tumors can be malignant, and some of their symptoms or imaging characteristics may resemble those of a myxoma.

Therefore, the nature of any mass inside the heart cannot be determined based on symptoms alone. Proper medical evaluation and imaging, particularly echocardiography, are required. CT or cardiac MRI may also be needed in some cases. Histopathological examination of the tissue after surgical removal can help confirm the diagnosis.

Causes of Cardiac Myxoma

Cardiac myxoma is a rare tumor that develops inside the heart and is usually benign. It most commonly occurs in the left atrium and may affect blood flow depending on its size and location.

What Is the Main Cause of Cardiac Myxoma?

In most cases, the exact cause of cardiac myxoma is unknown. It is believed to result from abnormal growth of certain cells within the heart, although the factors responsible for this abnormal growth are not completely understood.

Some factors and conditions associated with cardiac myxoma include:

1. Abnormal Changes in Heart Cells

Changes may occur in certain cells within the heart tissues, causing them to grow and multiply abnormally, resulting in the formation of a myxoma.

This does not mean that the person caused the tumor through a particular behavior or habit.

2. Genetic Factors

Most cardiac myxomas occur sporadically and are not associated with a known genetic disorder. However, a smaller proportion of cases are associated with genetic factors.

One of the most important genetic conditions associated with cardiac myxoma is Carney complex.

3. Carney Complex

Carney complex is one of the most important genetic conditions associated with cardiac myxoma.

A doctor may suspect this condition when there are signs such as:

• Multiple myxomas.
• Recurrence of the tumor after removal.
• Development of myxoma at a young age.
• A family history of similar cases.
• Other signs or tumors associated with the syndrome.

In such cases, the doctor may recommend a specialized genetic evaluation and appropriate testing.

4. Family History

Having more than one case of myxoma within a family may be significant, particularly when the tumors occur at a young age or recur in family members.

However, most cardiac myxomas are not associated with a clear family history.

5. Age and Sex

Cardiac myxoma can occur at different ages, but it is seen more frequently in adults and is more common in women.

Age and sex are not direct causes of the tumor; rather, they are associated with its distribution among different groups.

Do Heart Diseases Cause Cardiac Myxoma?

Usually, no. There is no known relationship indicating that common heart conditions, such as high blood pressure or atherosclerosis, directly cause cardiac myxoma.

Myxoma is also different from blood clots and heart valve diseases. It is a tumor arising from heart tissue rather than simply a collection of clotted blood.

Can Cardiac Myxoma Be Prevented?

Because the exact cause of most myxomas is unknown, there is no proven way to prevent their development. However, people with a family history or features suggestive of Carney complex may require more regular medical evaluation and follow-up.

Can Stress or Anxiety Cause Cardiac Myxoma?

There is no scientific evidence that stress or anxiety causes cardiac myxoma.

However, if a myxoma is already present, some associated symptoms, such as palpitations, shortness of breath, and fatigue, may become more noticeable during stress or physical exertion.

Can Food or Lifestyle Cause Cardiac Myxoma?

There is no specific food that has been proven to cause cardiac myxoma, and there is no known direct association between myxoma and a particular dietary pattern.

Symptoms of Cardiac Myxoma

The symptoms of cardiac myxoma vary from person to person depending on the tumor’s size, location, and effect on blood flow within the heart. A small tumor may not cause any symptoms during the early stages, while noticeable symptoms may develop as the tumor grows or begins to affect heart function.

The most common possible symptoms include:

1. Shortness of Breath

Shortness of breath is a common symptom and may occur:

• During physical activity.
• When climbing stairs.
• When lying down in some cases.
• Suddenly if the tumor obstructs blood flow through the heart.

2. Fatigue and Weakness

A person may experience fatigue, weakness, and reduced ability to perform normal activities, particularly if the tumor affects blood flow or the efficiency of the heart.

3. Heart Palpitations

A person may feel that their heartbeat is:

• Fast or forceful.
• Irregular.
• Or as though it briefly stops and then resumes.

Palpitations may occur because of the tumor’s effects on the heart or because of an associated heart rhythm disturbance.

4. Dizziness or Feeling Faint

If the tumor obstructs blood flow from the heart, less blood may reach the brain, potentially causing dizziness, unsteadiness, or a feeling of impending fainting.

5. Fainting

Fainting may occur in some cases, particularly if the tumor is large or mobile and interferes with blood flow through one of the heart valves.

6. Chest Pain or Pressure

Some people may experience chest pain or pressure. However, this symptom is not specific to cardiac myxoma, so medical evaluation is necessary to determine its cause.

7. Symptoms Similar to Heart Valve Disease

If the tumor is located in the left atrium near the mitral valve, it may obstruct blood flow from the atrium to the ventricle and cause symptoms resembling those of mitral valve narrowing, including:

• Shortness of breath.
• Fatigue.
• Palpitations.
• Reduced exercise tolerance.

8. Leg Swelling

Swelling of the feet or legs may occur in some cases, particularly if the tumor affects cardiac function and contributes to impaired circulation or fluid retention.

9. General Symptoms Resembling Inflammation

Some patients with myxoma may develop general symptoms such as:

• Fever.
• Sweating, particularly at night.
• Loss of appetite.
• Unintentional weight loss.
• General fatigue.

These symptoms may be associated with substances released by the tumor that affect the body's inflammatory response.

10. Neurological Symptoms

In some cases, small pieces of the tumor or blood clots associated with it may break away and travel through the bloodstream to other organs.

If they reach blood vessels supplying the brain, sudden neurological symptoms may occur, such as:

• Sudden weakness on one side of the body.
• Difficulty speaking.
• Sudden changes in vision.
• Difficulty moving or maintaining balance.

These symptoms require immediate emergency medical attention.

11. Symptoms Caused by Blood Vessel Obstruction

If part of the tumor or an associated blood clot travels into a blood vessel, it may cause an obstruction. The symptoms depend on which organ is affected and where the obstruction occurs.

Therefore, symptoms of cardiac myxoma can vary considerably from one person to another. Symptoms alone cannot confirm the diagnosis. Echocardiography (heart ultrasound) is one of the most important tests used to detect the tumor and determine its location, size, and effect on blood flow.

Treatment of Cardiac Myxoma With Medications

Cardiac myxoma is benign in most cases, but its presence inside the heart can obstruct blood flow or cause other complications. Therefore, once the diagnosis is confirmed, the main treatment is usually surgical removal of the tumor, rather than medication.

There is currently no medication proven to dissolve cardiac myxoma, remove it, or reliably stop its growth. However, doctors may prescribe certain medications to relieve symptoms, treat complications, or stabilize the patient before surgery, depending on the individual situation.

1. Medications for Symptoms of Heart Failure

If the myxoma obstructs blood flow or causes signs of heart failure, the doctor may use medications to control symptoms and improve the patient’s circulatory condition.

The choice of medication depends on heart function, blood pressure, the degree of obstruction caused by the tumor, and the patient’s overall health.

2. Diuretics

Diuretics may be used in some cases when fluid retention occurs. They can help relieve symptoms such as:

• Swelling of the feet or legs.
• Shortness of breath associated with fluid retention.
• Excess fluid accumulation in the body.

However, diuretics do not treat the myxoma itself. They only help relieve certain symptoms caused by its effects on the heart.

3. Medications for Heart Rhythm Disorders

In some cases, cardiac myxoma may be associated with heart palpitations or abnormal heart rhythms.

A cardiologist may prescribe an appropriate medication based on the type and severity of the rhythm disorder and the patient’s cardiac condition.

Heart rhythm medications should not be taken without medical supervision because treatment depends on the specific rhythm disorder, heart function, blood pressure, and other medications being used.

4. Anticoagulants and Medications for Blood Clots

Some patients may require anticoagulant medication if another medical condition makes it necessary, such as certain heart rhythm disorders or the presence of a blood clot.

However, it is important to distinguish between a blood clot and the myxoma itself. Anticoagulants do not dissolve or remove the myxoma.

The doctor determines whether anticoagulant therapy is appropriate after weighing the risk of blood clots against the risk of bleeding.

5. Medications for Associated Symptoms

If the patient has other symptoms or a separate medical condition associated with the myxoma, the doctor may prescribe appropriate medications to manage that condition.

These medications are considered supportive treatment and do not treat the myxoma itself.

Can Cardiac Myxoma Be Treated With Medication Alone?

Usually, no.

When cardiac myxoma is confirmed, particularly when it causes symptoms or interferes with blood flow through the heart, surgical removal is the primary treatment when appropriate.

This is because leaving the tumor in place may lead to complications such as:

• Obstruction of blood flow within the heart.
• Heart rhythm disturbances.
• Embolization of tumor fragments or associated blood clots into blood vessels.
• Deterioration of heart function in some cases.

The cardiac team determines whether surgery is necessary and when it should be performed based on the tumor’s size, location, mobility, symptoms, complications, and the patient’s overall health.

Can Cardiac Myxoma Disappear on Its Own?

Cardiac myxoma is not expected to disappear on its own, and there are no medications or dietary supplements scientifically proven to eliminate it.

Therefore, once a myxoma has been diagnosed, patients should not attempt to treat it with medications or supplements without medical supervision. Instead, they should follow the evaluation and monitoring plan recommended by their cardiologist.

What Happens After the Tumor Is Removed?

After surgical removal of a myxoma, the patient usually needs regular follow-up with a cardiologist to monitor heart function and check for possible recurrence.

The doctor may recommend echocardiography (heart ultrasound) at intervals determined according to the individual case. Follow-up is particularly important for people who have factors associated with a higher risk of recurrence, such as Carney complex.

Surgical Treatment of Cardiac Myxoma and Treatment Procedures

Surgical removal is the primary treatment for cardiac myxoma in most confirmed cases because medications cannot remove the tumor itself. The goal of treatment is to remove the tumor as completely as possible and reduce the risk of obstruction of blood flow through the heart or complications caused by tumor fragments or associated blood clots.

1. Conventional Surgical Removal of Cardiac Myxoma

Conventional surgical removal is one of the most commonly used approaches for treating cardiac myxoma. It is performed under general anesthesia and generally involves the use of a heart-lung bypass machine when required.

How Is the Procedure Performed?

In general:

• The patient is placed under general anesthesia.
• The surgeon accesses the heart through the appropriate surgical approach.
• A heart-lung bypass machine is used to maintain circulation during the operation.
• The heart chamber containing the tumor is opened to provide access to the mass.
• The surgeon identifies the tumor and its attachment to the heart wall or interatrial septum.
• The tumor and its attachment site are removed, with an appropriate amount of surrounding tissue when necessary to reduce the likelihood of leaving tumor tissue behind.
• The surgical site is carefully inspected to ensure that the tumor has been removed.
• Any damaged heart tissue or valves are repaired if necessary.
• The heart is restarted, and the patient is gradually weaned from the heart-lung bypass machine.
• The removed tissue is sent to the laboratory for histopathological examination to confirm the diagnosis.

2. Removal of Left Atrial Myxoma

Left atrial myxoma is one of the most common forms of cardiac myxoma.

The surgeon accesses the tumor through the appropriate surgical route, identifies its point of attachment, and carefully removes it together with its attachment site whenever possible.

If the tumor is attached to the interatrial septum, the surgeon may need to repair the portion of the septum that was removed. Depending on the size of the resulting defect, this may be done with direct suturing or with a suitable patch.

3. Removal of Right Atrial Myxoma

When the tumor is located in the right atrium, the surgeon selects an appropriate approach to access and remove the tumor together with its attachment site.

The surgical team pays particular attention to nearby tissues, valves, and blood vessels. The surgical technique varies according to the size, location, and extent of the tumor.

4. Removal of Ventricular Myxoma

A myxoma located in one of the ventricles is less common than atrial myxomas and may be more challenging to remove in some cases because of its proximity to:

• Heart valves.
• Papillary muscles.
• Chordae tendineae.
• The heart’s electrical conduction pathways.

The surgeon chooses the surgical approach that provides adequate visualization of the tumor while preserving healthy tissue and heart function as much as possible.

5. Minimally Invasive Surgery

At some specialized centers and in selected cases, cardiac myxoma may be removed using minimally invasive surgical techniques instead of conventional surgery.

Whether this approach is appropriate depends on several factors, including:

• The location of the tumor.
• Its size.
• Its attachment to the heart.
• The presence of multiple tumors.
• The patient’s overall health.
• The experience of the surgical team and available facilities.

6. Endoscopic-Assisted Surgery

Endoscopic techniques may be used in selected cases. The surgeon accesses the heart through smaller incisions and uses a camera and specialized surgical instruments.

This approach may reduce the size of the surgical incisions, but it is not suitable for every cardiac myxoma, particularly large or complex tumors that require extensive intervention or additional cardiac repairs.

7. Robotic-Assisted Surgery

At some specialized centers, robotic-assisted surgery may be used to remove selected cardiac myxomas.

The surgeon controls highly precise instruments through a robotic surgical system, which may allow the procedure to be performed through smaller incisions in certain cases.

Its use depends on:

• The expertise of the medical center and surgical team.
• Availability of the technology.
• The tumor’s location and size.
• The complexity of the case.

Therefore, robotic surgery is not available or appropriate for every patient.

8. Repair of the Interatrial Septum

If the myxoma is attached to the interatrial septum, the surgeon may need to remove part of the septum along with the tumor.

After the tumor is removed, the defect may be:

• Closed directly with sutures if it is small.
• Repaired with a patch if it is larger.

The goal is to restore the integrity of the interatrial septum and preserve normal heart function.

9. Heart Valve Repair During Tumor Removal

If the tumor has affected, extended into, or damaged a heart valve, the surgeon may need to repair the valve during the same operation.

The decision depends on the extent of valve damage. Not every patient with cardiac myxoma requires a valve procedure.

10. Heart Valve Replacement When Necessary

If a heart valve is severely damaged and cannot be adequately repaired, valve replacement may be necessary during the operation.

The cardiac team determines the type of valve and replacement approach based on several factors, including the condition of the valve, the patient’s age, and overall health.

This procedure is not a routine part of myxoma surgery and is performed only when there is a clear medical indication.

11. Removal of Multiple Myxomas

When more than one myxoma is present in the heart, the surgeon may need to remove all tumors that can be safely accessed during the operation.

Postoperative follow-up is particularly important in these cases because the risk of developing new tumors or experiencing recurrence may be higher in certain genetic conditions, such as Carney complex.

12. Conventional Open-Heart Surgery

Conventional open-heart surgery is a surgical approach used to access the heart and remove the myxoma. It is not a different type of myxoma.

In general, the procedure may involve:

• General anesthesia.
• Surgical access to the chest and heart.
• Use of a heart-lung bypass machine.
• Temporary cardiac arrest when necessary.
• Opening the appropriate heart chamber.
• Removal of the tumor and its attachment site.
• Repair of the interatrial septum or heart valves when necessary.
• Inspection of the heart to ensure adequate tumor removal.
• Restarting the heart and gradually discontinuing the heart-lung bypass machine.
• Closure of the surgical incision.
• Monitoring in the intensive care unit after surgery.