The presence of a left atrial (LA) myxoma may be suspected where there are symptoms and signs consistent with mitral valve disease of a relentlessly progressive nature, often accompanied by syncope or embolization.1 Alterations in symptomatology and physical signs, with changes in posture and constitutional manifestations suggestive of a chronic inflammatory process are also frequently found. Nevertheless, the diagnosis of LA myxoma continues to be made too often for the first time at surgery for suspected mitral stenosis, or at autopsy.Recently, clues to the diagnosis of LA myxoma by phonocardiography and apexcardiography have been described.2-7 These may facilitate the early diagnosis of this surgically curable condition. This report deals with a patient in whom the diagnosis was suspected from characteristic findings in the records of heart sounds and precordial movement. Detailed simultaneous pressure recordings in the left atrium and ventricle at cardiac catheterization permitted an analysis of physiologic correlates of the external findings. Patient Summary A 37-year-old man had the onset of dyspnea on exertion six months before ad¬ mission. There was no prior history of a heart murmur or rheumatic fever. Two months after onset of symptoms a heart murmur was heard for the first time. A month later he had an episode of pneu¬ monia which was complicated by lung ab¬ scess. This resulted in hospitalization at North Carolina Memorial Hospital where murmurs suggestive of mitral stenosis and insufficiency were heard. His dyspnea had become completely disabling, but at no time was there any dizziness or syncope. Symptoms were not affected by postural changes. Arrangements were made for his readmission for cardiac catheterization on subsidence of the pulmonary condition.On physical examination he was a well developed young man with normal color and no rash or fever. Blood pressure was 110/70 mm Hg. The neck veins were nor¬ mal, as were the carotid pulsations. The chest was clear, the heart not enlarged to the left. The apex movement felt normal, but it was initiated by a palpable first heart sound. There was a heave consistent with right ventricular hypertrophy at the left sternal edge. The first heart sound was unusually loud and had a crescendo con-figuration by auscultation which gave an acoustical impression of a presystolic mur¬ mur (Fig 1). The second heart sound split normally, but the pulmonary component was accentuated. A grade 2 holosystolic murmur was audible at the apex with transmission to the axilla. A loud third sound was present at the apex, but no diastolic murmur could be heard. X-ray films (Fig 2) showed a silhouette consistent with mitral disease: an enlarge¬ ment of the pulmonary outflow tract, left atrium, and right ventricle, along with some evidence of pulmonary vascular con¬ gestion. The electrocardiogram (Fig 3) was also consistent with LA enlargement and showed right axis deviation and early right ventricular hypertrophy.A phonocardiogram (Fig 1) showed a prolonged loud S, with an unusual ...
