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Among cardiac tumors, angiosarcoma is the most common primary malignancy, with a relatively higher prevalence in young male adults and a weak dominance in the right atrium as a primary site of growth. It is characterized by rapid infiltration of cardiac structures and possible metastasis to mediastinal and distant organs. The patient may be asymptomatic until advanced phases. It therefore has a poor prognosis. Diagnosis requires the use of multimodality imaging, including echocardiography, computed tomography (CT), cardiac magnetic resonance and positron emission tomography. The definitive diagnosis is based on histological examination. We report the case of a young male adult who was referred to the cardiology department for a syncopal event 5 h after cocaine assumption. During the diagnostic work-up, a chest X-ray was performed, showing multiple pulmonary lesions, which were evaluated with a chest CT highlighting the presence of a cardiac mass in the right atrium and ventricle. For this reason, a complete cardiological evaluation was performed. The clinical and instrumental suspicion of a malignant cardiac tumor was confirmed by multimodality imaging and finally by histological examination.

Barlow disease represents the extreme form of the degenerative mitral valve spectrum described by Carpentier. The myxoid degeneration of the mitral valve may result in a billowing leaflet or in a prolapse and myxomatous degeneration of the mitral leaflets. There are increasing evidences of the association between Barlow disease and sudden cardiac death. It is common in young women. Symptoms include anxiety, chest pain and palpitation. In this case report, the markers of risk for sudden death such as typical ECG changes, complex ventricular ectopy, a spiked configuration of the lateral annular velocities, mitral annular disjunction and evidence of myocardial fibrosis were assessed.