Presentation
Gabriella Forti Affiliation not present. Serena Favretto Affiliation not present. Franco Pertoldi Affiliation not present. Eleonora Ficarra Affiliation not present. Francesco Pelizzo Affiliation not present. Olga Vriz Affiliation not present. [monaldi-archives.org]
We are presenting a case of rheumatic valvular heart disease with giant left atrium who presented in our department with acute upper GI bleeding. [ncbi.nlm.nih.gov]
There were no symptoms related to the cardiac disease at the time of presentation. On examination, a single 8 x 6 cm size cystic lump with ill-defined margins and spherical shape was present in the epigastric region. [jpgmonline.com]
Entire Body System
- Pain
COMMENTS Case characteristics A 78-year-old patient with rheumatic heart disease and no cardiac symptoms such as dyspnea, nocturia, chest pain or palpitations. [wjgnet.com]
Most of the patients are symptomatic with that of shortness of breath, dysphagia, palpitations, chest pain, and thromboembolic events. Asymptomatic giant enlargement of the left atrium is rare. [ajs.tums.ac.ir]
A huge left atrium may create the compression of the surrounding structures such as the esophagus, pulmonary veins, respiratory tract, lung, inferior vena cava, and lead to dysphagia, respiratory dysfunction, peripheral edema, hoarse voice, or back pain [internalmedicine.imedpub.com]
Institute of Cardiovascular Diseases, Timisoara, Romania We report the case of a 65-year-old woman that recently presented with heart failure NYHA class III symptoms (intermittent nocturnal dyspnea, dizziness, asthenia) and postero-thoracic discomfort and pain [romanianjournalcardiology.ro]
Case report A 57-year-old woman, an ex-smoker with a history of non-insulin treated type 2 diabetes, dyslipidemia and bipolar disorder, went to the emergency department with epigastric pain and nausea of around a week's evolution, worsening the day before [elsevier.pt]
- Weakness
The exact mechanism is not known.It could be the intrinsic weakness of LA wall, as very few with RHD develop this. Many LAs resists dilatation even in the midst of extreme LA pressure. [drsvenkatesan.com]
Case 2 A 75-year-old man presented to our hospital with left arm weakness. He had a history of paroxysmal AF, but was not on anticoagulant therapy. [karger.com]
Dizziness 1 day 8 None, Patient survived SCD; Myxoma resected Turkman (6) 2007 1 73 M DOE months 8 yes Ito (13) 1987 1 28 M Syncope 7 days NA yes NA: not available Constitutional symptoms reported in approximately 20% of patients include myalgia, muscle weakness [bjmp.org]
Intrapericardial LAAA is thought to be due to a developmental weakness of left atrial wall or appendage. Two fifths of the cases of LAAA are congenital and the rest are acquired. [elynsgroup.com]
There are also isolated reports of GLA, where the inherent weakness of the atrial wall may be responsible for changes. [rbccv.org.br]
- Weight Loss
He also reported significant weight loss, loss of appetite and fatigue over several weeks. Physical examination revealed tachycardia, and moderate respiratory distress with prominent jugular venous distention. [bjmp.org]
Constitutional or systemic manifestations include fatigue, fever, weight loss, arthralgia, myalgia, erythematous rash and laboratory findings such as anemia and elevated erythrocyte sedimentation rate, C-reactive protein and globulins. [elsevier.pt]
- Inflammation
The suture reinforcement with bovine pericardium is suggested in cases of atrial tissue with friable or chronic inflammation [14]. REFERENCES 1. Apostolakis E, Shuhaiber JH. The surgical management of giant left atrium. [rbccv.org.br]
Gastrointestinal
- Nausea
There were no complaints of nausea, vomiting, jaundice or any other gastrointestinal symptoms. [jpgmonline.com]
Case report A 57-year-old woman, an ex-smoker with a history of non-insulin treated type 2 diabetes, dyslipidemia and bipolar disorder, went to the emergency department with epigastric pain and nausea of around a week's evolution, worsening the day before [elsevier.pt]
Cardiovascular
- Heart Disease
We discuss a case of a 78-year-old lady with no prior history of rheumatic heart disease with these findings with the unusual presentation of accompanied unilateral breast oedema as a manifestation of heart failure. [ncbi.nlm.nih.gov]
This photograph was published in the first edition (1931) of Heart Disease. It shows the heart of a patient with a giant left atrium due to predominate mitral regurgitation secondary to rheumatic heart disease. [circ.ahajournals.org]
Heart Diseases Also called: Cardiac diseases If you're like most people, you think that heart disease is a problem for others. But heart disease is the number one killer in the U.S. It is also a major cause of disability. [icdlist.com]
2015/25/4/113/172490 Introduction Rheumatic valvular heart disease still continues to be a burden in developing nations.Giant enlargement of atria in adults is rare and most commonly occurs in rheumatic valvular heart disease. [jcecho.org]
- Palpitations
Most of the patients are symptomatic with that of shortness of breath, dysphagia, palpitations, chest pain, and thromboembolic events. Asymptomatic giant enlargement of the left atrium is rare. [ajs.tums.ac.ir]
COMMENTS Case characteristics A 78-year-old patient with rheumatic heart disease and no cardiac symptoms such as dyspnea, nocturia, chest pain or palpitations. [wjgnet.com]
[…] giant atria in the context of rheumatic mitral stenosis and severe tricuspid regurgitation in an elderly lady Case report A 68-year-old woman with a history of rheumatic mitral stenosis and atrial fibrillation presented with dyspnea NYHA class III, palpitations [jcecho.org]
These patients usually have a long history of mitral valve disease, atrial fibrillation, palpitations, chest pain, dyspnea, hoarseness due to compression of the laryngeal nerve (Ortner syndrome) or other respiratory or hemodynamic complications. [rbccv.org.br]
Musculoskeletal
- Muscle Weakness
weakness, athralgia, fever, fatigue, and weight loss. [bjmp.org]
Neurologic
- Dizziness
Summary of 17 published cases of sudden cardiac death associated with cardiac myxoma in adults (1950-2008) Author/Reference Year No Age Gender Symptoms Interval Between Symptoms To Scd Size Of Myxoma In Cm Autopsy Vassiliadis (8) 1997 1 17 M Dizziness [bjmp.org]
University of Medicine and Pharmacy, Timisoara, Romania 2 Institute of Cardiovascular Diseases, Timisoara, Romania We report the case of a 65-year-old woman that recently presented with heart failure NYHA class III symptoms (intermittent nocturnal dyspnea, dizziness [romanianjournalcardiology.ro]
No triggering, relieving or aggravating factors were identified, although her symptoms were difficult to characterize; she also reported generalized arthralgia for some months, mainly during the day and not mechanical in nature, but no chest pain, dizziness [elsevier.pt]
- Asthenia
Medicine and Pharmacy, Timisoara, Romania 2 Institute of Cardiovascular Diseases, Timisoara, Romania We report the case of a 65-year-old woman that recently presented with heart failure NYHA class III symptoms (intermittent nocturnal dyspnea, dizziness, asthenia [romanianjournalcardiology.ro]
Treatment
This case illustrates the investigations and treatment options for GLA and the need for prompt assessment as it increases the risk of sudden death; therefore, its presence warrants careful evaluation and surgical intervention when appropriate. [ncbi.nlm.nih.gov]
Surgeon Mike Gordeev Different methods of left atrium walls suture application are widely used as a surgical option for atriomegaly treatment and sinus rhythm recovery. These techniques may also be accomplished by Cox-Maze procedure. [healthcare-in-europe.com]
Prognosis
There are several reasons why left atrial size can have a significantly negative impact on prognosis. [ncbi.nlm.nih.gov]
[…] is dependent on the adequacy of the residual left ventricular function, patients with severe left ventricular dysfunction having higher mortality rates. 25 In this case the early prognosis was favorable, but on the long term, the prognosis still remains [tmj.ro]
Long- and short-term prognosis is excellent and recurrence is rare, although six-monthly echocardiographic follow-up is recommended in all cases. 1 With this case report, we aim to highlight the fact that a diagnosis as common in daily clinical practice [elsevier.pt]
The patient’s family was notified of the poor prognosis and the decision was made not to resuscitate her if her condition deteriorated further. The patient ultimately became bradycardic and went into asystole at 5: 30 am. [bjmp.org]
Etiology
Abstract Giant left atrium is a rare condition, with a reported incidence of 0.3%, that is normally caused by rheumatic mitral valve disease but very rarely is caused by other etiologies. [ncbi.nlm.nih.gov]
Probably the best known of the vascular etiologic types is dysphagia lusoria. Dysphagia lusoria is the term applied to symptomatic esophageal compression by an arteria lusoria, an anomalous form of the right subclavian artery (1, 2). [annals.org]
In a patient, the congenital etiology was severe with mitral and tricuspid valve insufficiency and with GLA. [rbccv.org.br]
We performed tridimensional (3D) transthoracic echocardiography to study the etiology of MR. [tmj.ro]
Conclusion Giant atria due to rheumatic etiology are still prevalent in developing nations. Despite massive enlargement many patients may remain asymptomatic. [jcecho.org]
Pathophysiology
They examine the causes, pathophysiology, investigation, diagnosis, and treatment (pharmacological and non-pharmacological) with emphasis on recently-published studies. [books.google.com]
Giant Left Atrium Pathophysiology: The commonest cause of a large left atrium is mitral regurgitation, usually due to rheumatic heart disease. [individual.utoronto.ca]
Pathophysiology of mitral valve disease. In: Cohn LH, Edmunds LH Jr, editors. Cardiac Surgery in the Adult. New York, USA: McGraw-Hill; 2003. p. 901-31. 3. Surani S, Surani A, Varon J. Giant right atrium secondary to mitral stenosis. [jcecho.org]
Left ventricular aneurysms: pathophysiologic observations and standard resection. Sem Thorac Cardiovasc Surg 1997;9:113-22. 9. Grieco JG, Montoya A, Sullivan HJ, et al. Ventricular aneurysm due to blunt chest injury. [tmj.ro]
Prevention
Calcification of posterior left atrial wall prevented a completely satisfactory reduction of atrial size and the severity of ventricular adhesions from the previous pericardial procedure resulted in very long cardiopulmonary bypass time with severe bleeding [ncbi.nlm.nih.gov]
Volume reduction is useful to prevent complications; the indication for surgery is the presence of intracardiac or extracardiac compressive symptoms and several techniques have been proposed such as simple wall placation or resection and primary suture [romanianjournalcardiology.ro]
Surgical treatment seems to be important in management of LAAA even in the absence of symptoms to prevent complications [1,3,8,10]. [elynsgroup.com]
Regardless of mechanism, the diagnosis of a left atrial thrombus ball should be regarded as an urgent indication for preventive surgery( 3 ). [ispub.com]
References European Atrial Fibrillation Trial Study Group: Secondary prevention in non-rheumatic atrial fibrillation after transient ischaemic attack or minor stroke. Lancet 1993;342:1255-1262. [karger.com]