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Atrial myxomas are the most common benign tumour of the heart. They progressively grow in size, varying from 2 cm to 6 cm, based on previous reports. They can mimic mitral stenosis when they block the mitral valve outlet, and present with right heart dysfunction and pulmonary hypertension. Atrial myxomas are usually associated with a good prognosis when resected. Echocardiography is the primary clinical diagnostic modality, confirmation is by histopathology while surgery remains the mainstay of definitive therapy. The author presents a case involving a 54-year-old man with a history consistent with biventricular heart failure. Echocardiography revealed a giant left atrial homogeneous mass (6.8 cm × 5.9 cm) filling the massively dilated left atrium and protruding with systole into the mitral valve opening. Pulmonary hypertension was also present. Electrocardiography revealed left atrial enlargement, isolated frequent ventricular premature complexes, right axis deviation, left ventricular hypertrophy and diffuse T wave abnormalities. The patient was managed conservatively and is presently awaiting surgical intervention. Giant left atrial myxoma presenting with pulmonary hypertension can be an etiology of heart failure among Black Africans. Appropriate clinical history and investigations are advised when managing heart failure subjects to identify potential etiologies that have the potential for cure.
