A cardiac mass in a breathless patient
A 73 year old woman, Mrs K, presented to her general practitioner with a one month history of increasing breathlessness and fatigue. She had no other symptoms and no medical history. Mrs K was a non-smoker and was not taking any drugs.
On examination, Mrs K’s respiratory rate was 14 breaths per minute and her heart rate was 64 beats per minute. Her blood pressure was 125/73 mm Hg and she was clinically euvolaemic. She was found to have a new systolic murmur, loudest at the apex, with bibasal fine crackles. Her elecrocardiogram showed sinus rhythm. Her C reactive protein level was raised at 12 mg/L (<10 mg/L).
Mrs K was referred to hospital because of her symptoms and the results of her examination. A transthoracic echocardiogram (figure) showed a mobile mass in the left atrium, measuring 7 × 3.5cm . It was protruding through the mitral valve, resulting in