Heart attack
The patient presented himself to the hospital with chest pain. For illustrative purposes only. Image Credit: Agency

Dubai: A 51-year-old man of Indian origin in Dubai has been detected with a heart that has five, instead of four, chambers.

Dr. Sachin Upadhyaya, Cardiology Specialist, Aster Hospital, told Gulf News that the man presented himself to the hospital with chest pain. He said the patient was also on medication for hypertension.

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“Under the circumstances, we conducted an ECG which turned out normal. A cardiac enzyme test was also done but there was nothing off the mark. We planned a 2D Echo test and on the face of it, the function of the heart also appeared normal. However, a closer look at the structure of the heart revealed a linear band in the left atrium or upper chamber,” said Dr Upadhyaya, who immediately suspected that the patient had a rare condition.

A diagram of the heart showing the cor triatriatum sinister condition. Image Credit: Vijith Pullikal/Gulf News

He said alongside the two ventricles (right ventricle and left ventricle), an additional chamber was found within the left atrium due to the presence of the membrane characteristic of the condition called cor triatriatum sinister. The abnormality pertained to the left atrium, resulting in an overall count of five chambers in the heart.

Further investigations were done and it was confirmed that the man indeed had cor triatriatum sinister.

Dr. Sachin Upadhyaya

He said cor triatriatum sinister is an extremely unusual congenital issue where the left atrium is divided into two chambers by a membrane, resulting in a total of three atria within the heart.

Dr. Upadhyaya said while the condition was confirmed, the task of establishing whether it was causing the chest pain remained. This meant more tests, including some blood work and a cardiac MRI, had to done. “Subsequently, we were able to conclude that the presence of the linear membrane was not responsible for his chest pain. So we treated him for his symptoms with medication and he was able to return to normality soon.”

How rare is cor triatriatum sinister?

Cor triatriatum sinister is an extremely rare condition, occurring in only 0.004 per cent of the general population and accounting for 0.1 to 0.4 per cent of all cases of congenital heart anomalies. Its detection, especially in adults, can be incidental and requires careful evaluation to determine its subtype and associated symptoms, as well as to plan further treatment.

The doctor said patients with cor triatriatum sinister require surgery if deemed necessary. “Usually, these patients are more prone to cardiac arrhythmia, formation of clots due to a sluggish flow of blood which can in turn lead to a stroke. There could also be a series of degenerative changes which could lead to breathlessness and other complications,” he said.

Patients with cor triatriatum may have other associated congenital heart defects, requiring careful evaluation and imaging. “In fact, in 70 per cent of cases, an associated Atrial Septal Defect (ASD) is present. There is a slightly higher prevalence in males. If the blood flow is restricted between the chambers of the left atrium, due to a narrow opening, the patient may experience symptoms early in life. If the opening is non-restrictive, patients may remain asymptomatic until later in life. However, the communicating orifice may undergo changes over time due to fibrosis and calcification, potentially leading to symptoms,” the doctor said.

He said, “This case highlights the need for comprehensive heart checks in adults above 35 years, especially when symptoms appear unusual,” he added.

The patient was unavailable for comment.