Myxoma physical examination

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2]Ahmad Al Maradni, M.D. [3]

There are no specific physical findings for cardiac myxoma. The ascultatory presence of a “tumor plop” (which is caused by the obstruction of the mitral valve orifice by the tumor) on physical examination is highly suggestive of cardiac myxoma. Common physical examination findings of cardiac myxoma include systolic or diastolic murmurs (depending on size, mobility, and location of the tumor).

Physical examination of patients with cardiac myxoma is usually remarkable for:^[1][2][3]

• Examination of the extremities may also reveal signs of an embolic phenomenon
• Blue discoloration of the skin, especially the fingers (Raynaud’s phenomenon)^[2]
• Clubbing – curvature of nails accompanied with soft tissue enlargement of the fingers^[2]
• Swelling – any part of the body

• Chest examination may reveal fine crepitations consistent with pulmonary edema^[4]

Auscultatory findings are characteristically variable and depend most of the time in body position. Moreover, pericardial friction rub may sometimes be present in patients with right atrial tumors.^[5]

• A “tumor plop” (a sound related to movement of the tumor) can be heard. This is defined as a protodiastolic murmur, it can be heard 80 to 150 msec after the second heart sound.
• Abnormal heart sounds, or murmurs may be heard.
• Sounds may change when the patient changes position.
• In patients with left atrial myxomas, S1 is often loud and widely split, because the tumor has caused a delay in the closure of the mitral valve.
• Diastolic murmurs are due to the obstruction of the left or right ventricle.
• Systolic murmurs are related to the narrow closure of the atrioventricular valves.
• In most cases, a common ascultatory finding is the accentuated first heart sound and the loud pulmonary component of the second heart sound.

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