the commonest neoplasms of the heart are metastatic ( autopsy frequency 1.5 - 21% ) . three - quarters of these are benign and three - quarters of these are myxomas.(1 ) myxomas most commonly occur in the left atrium ( 90% ) and are generally attached to the atrial septum in or adjacent to the fossa ovalis . they can also be found in the right atrium , or right or left ventricles . they tend to present in the age group 30 - 60 years , and more commonly in females . syndrome myxoma , a genetic disorder should be suspected in individuals who are under 40 years of age with multiple myxomas.(1 ) carney s complex , a neuroendocrine - cardiac syndrome is a common cause of familial recurrent cardiac myxomas . other characteristics include pigmented skin lesions , schwannomas and multiple recurrent mucocutaneous myxomas , and endocrinal neoplasms / overactivity.(2 ) myxomas may be asymptomatic ( these being picked up incidentally on routine echocardiography or other imaging ) . obstruction of a heart chamber by a large myxoma may lead to transient loss of cardiac output with syncope and pulmonary hypertension , resulting in pulmonary oedema and breathlessness . fragments of the tumour may also embolise causing systemic constitutional symptoms such as fever and arthralgia.(1,3 ) structurally most myxomas have a stalk , and are gelatinous with a broad base . the surface may be either friable or villous.(4 ) histologically , they are made up of polygonal multipotential mesenchymal cells which are found in the subendocardium . these cells are thought to be neuroendocrine in origin , and have the ability to differentiate into fibroblasts , smooth muscle cells , endothelial cells and neuroendocrine cells.(2 ) diagnosis of cardiac myxomas is usually made using transthoracic echocardiography ( tte ) , which has a 95.2% detection rate . we present a 42 year old female who was referred to the cardiology service by her gp . she reported a 5 week history of new york heart association ( nyha ) functional classification class ii iii dyspnoea , a generalised lack of energy and a  flu - like illness , with cough , for which her gp prescribed antibiotics . 3 weeks prior to presentation , she experienced a tia - like episode , with right - sided facial and upper limb weakness , and dysarthria . this episode lasted about 30 minutes . on examination , a soft ( 2/6 ) systolic murmur was heard over the right sternal edge . a further mass or extension of this was also seen in the right ventricular outflow tract . mri and ct thorax ( figures 1 & 2 ) demonstrated a 4.1 cm x 9 cm x 4.1 cm lobulated mass within the right ventricle , obstructing the right ventricular outflow tract . ct thorax demonstrating a mass within the right ventricle mri thorax demonstrating the same mass as in figure 1 patient was referred for urgent surgery . at surgery under cardiopulmonary bypass , the right ventricle was explored through incisions in the right atrium , and in the infundibulum . an 8 cm x 7 cm mass was found to be attached to the inflow of the right ventricle ( the anterior tricuspid leaflet ) and the apex . a further incision in the apex of the right ventricle was required to resect the tumour with all its attachments . the anterior leaflet of the tricuspid valve was excised and the valve reconstituted as a bicuspid valve . cardiac myxomas are a rare cause of various signs and symptoms and should be considered in the differential diagnosis . some are picked up incidentally . whatever the presentation , the management of a myxoma remains prompt surgical resection to prevent embolisation or occlusion of an intracardiac valve .
myxomas are the commonest primary cardiac tumours 
 . they may be asymptomatic , and picked up incidentally , or be the cause of congestive heart failure , arrhythmias and/or murmurs . 
 echocardiography is necessary for diagnosis . 
 surgical resection is recommended to prevent further complications . 
 a rare symptomatic ventricular myxoma is presented in this case report .