Abstract
Transthoracic echocardiography (TTE) in the emergency room during initial evaluation plays a crucial role in the diagnosis and therapeutic decision-making for patients with acute coronary syndrome (ACS). At our institution, certified cardiac sonographers are available 24 hours a day, including nights, allowing for full TTE studies to be performed promptly in the emergency setting. Here, we present a rare case in which an initial TTE performed in the emergency room was pivotal in diagnosing a left atrial myxoma complicated by takotsubo syndrome in a patient initially suspected of having ST-elevation myocardial infarction (STEMI). The patient was a woman in her 50s who developed persistent chest pain while riding a bicycle on a Saturday evening. She was referred to our hospital by a duty physician with a presumptive diagnosis of STEMI. Initial TTE in the emergency room revealed a well-defined, highly mobile, multilobulated mass with a stalk arising from the interatrial septum, strongly suggestive of a left atrial myxoma. Additionally, severe regional wall motion abnormalities were noted in the left ventricular apex and hypercontractility in the basal portion of the left ventricle, prompting consideration of takotsubo syndrome or myocardial infarction secondary to tumor embolism. Emergency coronary angiography revealed no significant coronary stenosis or occlusion. The following day, urgent surgical resection of the tumor was performed, and histopathology confirmed the diagnosis of a left atrial myxoma. Subsequent cardiac magnetic resonance imaging and nuclear imaging studies led to a final diagnosis of takotsubo syndrome. This case underscores the critical importance of high-quality TTE imaging, even under time constraints and limited patient positioning during initial emergency evaluation. The diagnostic clarity provided by early echocardiographic assessment was instrumental in guiding appropriate and timely therapeutic intervention.
