Cardiac myxomas are benign soft tissue tumors occurring more frequently in women than in men. Although they can be present at any age, they are most commonly seen in the 30 to 60 year age group. They can be asymptomatic or can cause an embolism, obstruction within the heart or other constitutional symptoms.
Cardiac myxomas are the commonest amongst benign tumors of the heart . Although they have been reported in individuals of all ages, they are usually seen between the third and the sixth decade of life. Sporadic myxomas occur more commonly in women and the female to male ratio has been reported to be 2.7:1 . A majority of the myxomas occur on the left side of the heart while 25% occur on the right side .
A small proportion of the cardiac myxomas are familial in origin  and can either be part of a syndrome (Carney's complex with its subsets LAMB syndrome or NAME syndrome)     or can be non-syndromic . The familial Carney's complex is inherited in an autosomal dominant manner and characterized by skin pigmentation, cardiac and soft tissue myxomas, accompanied by endocrine dysfunction. Compared to sporadic myxomas, familial cardiac myxomas have been reported to occur at an earlier age, have less female preponderance and a higher incidence of right heart involvement and recurrence .
Affected individuals usually present with symptoms secondary to embolism, mechanical obstruction within the heart or with constitutional symptoms (classic Goodwin's triad). A minority of the patients with myxomas are asymptomatic  and they are detected incidentally. The site of the embolization depends on whether the myxoma is located on the right or the left side of the heart and the presence or absence of an intracardiac shunt. Other presenting features include those due to mitral regurgitation and conduction abnormalities like atrial fibrillation or flutter.
The workup of the patient depends on their manner of presentation. In all cases, a detailed history and physical examination are mandatory. If familial cardiac myxoma is suspected from family history then a detailed physical examination for other features of the syndrome should be performed.
Laboratory studies are not specific and findings can include hemolytic anemia (secondary to mechanical damage of erythrocytes), elevated levels of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and serum gamma globulin. Levels of serum interleukin- 6 may be elevated and they are used as a marker for determining recurrence.
Electrocardiography (ECG) is performed in all patients and may show atrial fibrillation, flutter or other conduction abnormalities. Two-dimensional echocardiography (2D ECHO) is used to visualize all the cardiac chambers and to evaluate the location, size, and mobility of the myxoma. Transesophageal echocardiography is a more sensitive test than the 2D ECHO and detects myxomas as small as 1 mm in diameter.
Chest radiographs are used to identify pulmonary edema, tumor calcification, and cardiomegaly while magnetic resonance imaging (MRI) detects tumor size, mobility and its site of attachment. Computed tomography (CT scan) is performed to differentiate between a myxoma and an intracardiac thrombus. While a thrombus is smaller than a myxoma, the myxoma has specific morphological characteristics (shape, mobility and ability to prolapse) which help to identify it .
PRKAR1A molecular genetic testing is recommended in all patients suspected to have Carney's complex and if positive, then their family members are also evaluated for cardiac myxomas