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A 57-year-old woman with no notable medical history presented with a 4-month history of leg swelling and dyspnea on exertion. Her symptoms had been progressively worsening for 2 weeks before admission, and in that time she had had three syncopal episodes. One month earlier, she had been able to walk at least 1.6 km (1 mi) without limitation but now could walk only one block before tiring. An electrocardiogram showed right-axis deviation and right ventricular hypertrophy. Physical examination revealed a grade 3/6 holosystolic murmur at the right upper sternal border that radiated to the axilla and an early diastolic decrescendo murmur at the left lower sternal border. Transthoracic echocardiography showed a large myxoma consuming the entire left atrium during systole (Panel A), with protrusion into the left ventricle during diastole (Panel B and video, available with the full text of this article at NEJM.org). Surgical removal of the myxoma was planned, but the patient died the night before surgery.
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