Myxoma, dyspnoea, tinnitus, scoliosis, and alopecia.

摘要

In June, 2009, a 51-year-old woman presented to us with progressive dyspnoea on exertion, pulsatile tinnitus, back pain, and hair loss. Dyspnoea had started at least 1 year previously. During this time her exerdse tolerance had decreased from an active lifestyle to the inability to climb stairs. 2 months before presentation, she started to have intrusive, pulse-synchronous tinnitus in her left ear only. Hair loss had started 2 years ago, and she had taken to wearing a wig. She admitted to back pain. Her medical and family history were unremarkable. She was taking atenolol and hydrochlorothiazide at low doses for hypertension. Physical examination showed diffuse non-scarring alopecia. She had a stooped posture, leaning slightly to the left. Pulse rate was 82 bpm and blood pressure 132/80 mm Hg. Auscultation of the praecordium was notable for accentuated heart sounds as well as systolic and diastolic murmurs with positional variation in intensity. The lungs were clear. ECG and chest radiography were unremarkable. Transthoracic echocardiography revealed a giant left atrial mass that prolapsed into the ventricle during diastole (figure A).