# Cardioembolic Stroke and ST-Segment Elevation Myocardial Infarction (STEMI) Due to Left Atrial Myxoma in an Elderly Pilgrim: A Case Report

## TL;DR

An elderly woman suffered a cardiac arrest and multiple strokes due to a left atrial myxoma, highlighting the importance of early echocardiography in diagnosing such rare but serious conditions.

## Contribution

This case report highlights the rare but critical presentation of left atrial myxoma causing STEMI and stroke, emphasizing diagnostic considerations in elderly pilgrims.

## Key findings

- A left atrial myxoma was found to cause pulseless electrical activity arrest, STEMI, and posterior circulation infarcts.
- Echocardiography confirmed a mobile septal mass prolapsing into the left ventricle.
- The case underscores the need for early echocardiography in sudden collapse to avoid misdiagnosis.

## Abstract

Left atrial myxomas are the most common primary cardiac tumors, but may present deceptively. A 77-year-old woman with type 2 diabetes collapsed during Tawaf (circumambulation of the Kaaba in Makkah) with pulseless electrical activity arrest. Return of spontaneous circulation was achieved, and subsequent evaluation revealed a large left atrial myxoma complicated by inferior ST-segment elevation myocardial infarction (STEMI) and multiple posterior circulation infarcts. Echocardiography demonstrated a mobile septal mass prolapsing into the left ventricle, while brain imaging confirmed bilateral cerebellar and pontine strokes. The patient was stabilized, started on antithrombotic therapy after hemorrhage was excluded, and later transferred for surgical excision. This case illustrates the unusual convergence of cardiac arrest, myocardial infarction, and embolic stroke from a single atrial myxoma. It emphasizes the importance of early echocardiography in avoiding misdiagnosis and inappropriate treatment. In the setting of Hajj and Umrah (Islamic pilgrimages to Makkah), where elderly pilgrims with diverse comorbidities gather, structural cardiac lesions, though uncommon, should be considered in the differential diagnosis of sudden collapse.