‘Stress and anxiety’, she was told. What doctors later found inside her heart

She consulted cardiologists, at least four of them. “They attributed it to stress and anxiety.” It took advanced imaging to reveal that her heart was hiding something none of the routine tests had shown, a tumour.

For Rima, the story stretched back 13 years. At eight, she had undergone surgery to close an atrial septal defect — a hole in the wall separating the heart’s two upper chambers. It was a recognised congenital condition, and the procedure was expected to correct the problem. But she remained breathless on exertion. By 21, the symptom had persisted for more than a decade. That was when she was referred to Safdarjung Hospital, where doctors took another look. What they found was not a recurrence of the original problem, but something else entirely: a rare congenital condition called cor triatriatum, in which an abnormal membrane divides the left atrium into two chambers and can obstruct the flow of blood returning from the lungs.

Both their cases are uncommon. But together, they illustrate a larger reality of heart disease in the young: Symptoms can be subtle, diagnoses can be difficult and a normal-looking heart on an initial test does not always tell the whole story.

When tests were normal

For Sayanee, the initial investigations offered little reason to suspect a tumour. Her echocardiograms showed a structurally normal heart. There was no visible valve abnormality, no obvious mass and no impaired pumping function. Her ECG showed persistent tachycardia or racy heartbeats, but no other clear clinical marker pointed towards a defect.

In that context, attributing a young patient’s palpitations and elevated heart rate to anxiety was not, in itself, an extraordinary conclusion. As Dr Udgeath Dhir, Cardiothoracic and Vascular Surgeon at Fortis Hospital, Gurugram, who eventually treated Sayanee, explains, “The location of her tumour was unusual and could remain invisible on an echocardiogram. An echocardiogram uses sound waves to produce images of the heart. Depending on the angle and the chamber being examined, a mass can occupy an area that is difficult for the technique to visualise.” A cardiac MRI with a CT scan revealed a mass inside the heart, what is called a cardiac lipoma. It was initially measured at nine centimetres on imaging, although a subsequent biopsy showed a slightly different size.

Heart risks women should ignore. (Source: Express gfx)

A lipoma is a benign tumour made up of mature fat cells. “Cardiac lipomas are very unusual,” Dr Dhir says. They account for around eight per cent of cardiac tumours, while cardiac tumours themselves are extremely rare.

The problems of Sayanee’s tumour were largely connected to its location. The heart is a compact organ, with little room for an abnormal mass. A tumour can interfere with its mechanical function or disrupt its electrical system. “In Sayanee’s case, the lump was near the heart’s electrical system and led to her episodes of dangerously fast heartbeats,” says Dr Dhir.

The day everything changed

“When my doctors first told me that I had a lipoma inside my heart, honestly, I felt nothing,” recalls Sayanee. She assumed there would be a solution. Then, on the day before surgery, her condition deteriorated. The blackouts returned. Her heartbeat began swinging wildly. By evening, she was in the ICU. The operation required open-heart surgery. “We put her on a heart-lung bypass machine so that her organ could be safely stopped and we could work on it without depriving the rest of the body of oxygenated blood. Then we carefully removed the tumour while preserving the surrounding heart muscle and the electrical pathways responsible for a normal heartbeat,” says Dr Dhir.

Precision mattered more than speed here — cut too little, and the lipoma could recur or continue interfering with rhythm; cut too aggressively, and the surgeon would risk damaging the very pathways responsible for a normal heartbeat. “After three months of the procedure, her heart function is now normal.”

The surgery left Sayanee with a different understanding of time. “I realised that life is not just studies, my passion and my career. There is much more to life than that,” she says. She remembers a line from the Rajesh Khanna film Anand: “Zindagi jo hai lambi nahi, badi honi chahiye” — life does not need to be long; it needs to be large.

The diagnosis that wasn’t the whole story

Rima’s journey was less sudden, but no less revealing. At eight, she had undergone surgery to close a hole in her heart. Thirteen years after her first surgery, she continued to experience breathlessness on exertion. “She was 21 when she came to us,” says Dr Anubhav Gupta, professor of Cardiology at Safdarjung Hospital. “That’s when we found a rare condition where an abnormal fibrous membrane divides the left atrium, creating two chambers. Depending on how much the membrane obstructs blood flow, symptoms can range from limited to significant. In some patients, symptoms become apparent early in life. In others, they may emerge or persist later,” he adds.

In simple terms, the abnormal membrane acts like a partial blockage between two parts of the left atrium. Blood coming from the lungs has to squeeze through an opening in the membrane before reaching the left ventricle. If the opening is large, blood flows normally and the condition may cause few or no symptoms. If the opening is narrow, blood flow is restricted, causing pressure to build up behind the blockage and toward the lungs. This can lead to breathlessness, fatigue, reduced exercise tolerance, and eventually increased strain on the heart.

After imaging tests, Rima underwent an open-heart surgery like Sayanee’s and now has no blood flow or breathing problems. Dr Gupta says her case illustrates why persistent symptoms deserve a fresh look. “A thorough evaluation prior to surgery and meticulous examination during surgery are essential, particularly when the clinical picture does not completely fit the initial diagnosis,” he says.

There is another reason for vigilance: more than one structural abnormality can coexist.

Sayanee and Rima arrived at their answers by very different routes. Both of them are doing well. Both are also living more consciously in the present. For Sayanee, that means not postponing the things that matter. “If I have to tell someone I love that I love them, I wouldn’t wait till tomorrow,” she says. “I’ll tell them today itself.” Rima has had a bigger takeaway. “Don’t let any sign slip through. You’ve got to listen to your own heart.”