PMC9252612_01
Electrocardiogram.
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After initial noninvasive diagnostics (electrocardiogram, cardiac biomarkers), the patient was immediately transferred to a clinic with a cardiac catheter laboratory because of ST-segment elevations ( Fig. 1 ) and highly elevated cardiac biomarkers (CK max. 61.22 micromol/s.l., CK-MB max. 4.82 micromol/s.l.).
Primary emergency percutaneous coronary intervention. (
A and B
) Left coronary artery with the arrow marking the total occlusion of the left anterior descending artery. (
C
) Right coronary artery with the arrow marking the high-grade stenosis in segment 3.
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Coronary angiography revealed an occluded proximal left anterior descending (LAD) artery in segment 7 ( Fig. 2A, B ) and moderate-to-severe stenosis of the right coronary artery in segment 3. 
Giant right atrial myxoma (*). (
A
) Transesophageal echocardiography. (
B
) Computed tomography scan. (
C
) Magnetic resonance tomography scan.
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The patient was then given dual antiplatelet therapy following guidelines.  Immediately after the emergency PCI, he underwent transthoracic echocardiography, which surprisingly revealed a giant RA mass measuring 40 x 50 mm prolapsing into the right ventricle ( Fig. 3 ).  Our department took additional computed and magnetic resonance tomographs to improve surgical planning ( Fig. 3A, B ).
(
A
) Initial left anterior descending artery's result after the first passage with the guidewire through the total occlusion and finally (
B
) after implanting two drug-eluting stents. (
C
) Final result of the second inspection of the right coronary artery's percutaneous coronary intervention.
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Four days after the culprit lesion's primary PCI, implanting a DES eliminated the remaining stenosis in the right coronary artery's segment 3 ( Fig. 4C ).
Histopathological examination using light microscopy. Hematoxylin-eosin staining:inlay Alcian blue staining with periodic acid-Schiff reaction. Tumor with few cells and elements located subendothelial in loose, elongated structures, dominated by a myxoid matrix.
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The tumor's macroscopic appearance revealed an irregular, gelatinous exterior of friable, soft consistency corresponding to a papillary myxoma confirmed later histopathologically ( Fig. 5 ).