Introduction Myxomas are the most frequent type of benign tumour of the heart, typically found in the left atrium. We present a case of myxoma with cardioembolic stroke coexisting with coronary artery disease.

Case Presentation 39-year-old man, active smoker with bilateral sensorineural hearing loss, and dyslipidaemia presented with dizziness. After initial treatment failed, CT brain and perfusion scan revealed left cerebellar infarct and right parietal haemorrhage. Additionally, chest X-ray showed cardiomegaly. ECG showed sinus rhythm, T inversion at anterior lead, and poor R wave progression. Further history, over the past six months, he had been experiencing symptoms of heart failure, chest pain, and significant weight loss. Given the atypical combination of ischemic and haemorrhagic strokes, cardioembolic source was suspected. Transthoracic echocardiography revealed a large left atrial mass with ejection fraction of 60–65%. A detailed transoesophageal echocardiogram showed a multi-lobulated mass (5.27 × 3.06 cm) attached at IAS prolapsing into mitral valve causing pseudo MS. Further evaluation with coronary angiography revealed severe stenosis (80–90%) in the proximal left anterior descending artery. He then underwent surgery to remove the atrial myxoma and received stenting of the LAD artery during the same admission. Histopathological examination confirmed cardiac myxoma. He was discharged on dual antiplatelet therapy and is recovering well.

Discussion Patients with myxoma are often asymptomatic. Some may experience embolic events, primarily affecting the cerebral arteries. Prompt surgical removal of myxoma is essential once diagnosed to prevent further embolic events. Cerebrovascular events in young patients should raise suspicion of myxoma, making echocardiography an essential diagnostic tool. Additionally, coronary angiograms should be performed in resource-equipped centres to assess for any co-existing coronary artery disease and to determine if the artery is supplying the myxoma. In our case, the patient successfully underwent both tumour resection and percutaneous coronary intervention (PCI) during the same hospitalization, which proved to be both time-efficient and cost-effective for both the patient and clinician.

Conclusion This report emphasizes atrial myxoma should be considered as a potential source of embolism in young patients presenting with acute stroke. Early diagnosis with bedside echocardiography and prompt surgical intervention are crucial to reduce morbidity.