US5: Positional Chest Pain

Triage: pt in from home c/o chest pain since yesterday. states its worse when she lays down and describes pain as a pinching sensation. denies SOB. PMH heart tumor. vss.

History: 52-year-old female with a known history of an atrial myxoma diagnosed that is about 1.7 x 1.4 cm in size. She comes in today because her chest pain episodes have been getting worse for the last 2 days it is a pinching feeling that is more severe than has been in the past lasting longer radiates more. It is triggered by lying supine. It has is associate with nausea but no shortness of breath or syncope. No fever or other complaints

Vital Signs: T: 36.5 °C (Oral) HR: 62 (Monitored) RR: 18 BP: 123/80 SpO2: 100%

Exam: normal

Labs: Hb 8.3 microcytic

POCUS: Postional chest pain (click here to download and view)

What is the most likely cause of chest pain?

A) Anemia
B) Anxiety
C) CAD
D) Myxoma

“BRADY” DOWN FOR THE EKG ANALYSIS & 1-MINUTE CONSULT

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Echo interpretation: there is a 2-3 cm hyperechoic mass in the left atrium towards the bottom of the screen. On the video it pops in and out of view

QUIZ ANSWER: What is the most likely diagnosis?

A) Anemia
B) Anxiety
C) CAD
D) Myxoma – CORRECT

Case Outcome: admitted and seen by cardiology and cardio-thoracic surgery

1-Minute Consult

Myxoma: Benign atrial tumor; soft, jelly-like mass of heart’s lining. Women >men, adults >kids
Symptoms: None, SOB, CP, palpitations, syncope, near-syncope, CVA, PE
Diagnosis: Echocardiogram or cardiac MRI
Treatment: CT surgery to prevent complications

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