Background: Primary cardiac tumors are exceedingly rare, with myxomas representing the most common benign type among these tumors, predominantly located in the left atrium. Biatrial involvement is an exceptional presentation, reported in less than 2.5% of cases. The terms bilateral and biatrial atrial myxoma are often confused and used interchangeably. We present a rare case of atrial myxoma involving both chambers, resected via a minimally invasive endoscopic approach, accompanied by a literature review. Case Presentation: A 52-year-old male with a three-month history of progressive fatigue and exertional dyspnea was found, on transthoracic echocardiography and cardiac MR, to have two intracardiac masses affecting both atria. Intraoperative transesophageal echocardiography confirmed the presence of mirror-image myxomas attached to the interatrial septum, in the absence of any septal defect. The tumors were excised en bloc, including the septal attachment, using a minimally invasive endoscopic approach. Histopathological examination confirmed the diagnosis of atrial myxoma, and the postoperative course was uneventful. Conclusions: Bilateral and biatrial atrial myxomas are exceedingly rare forms of cardiac tumors. In many cases, the first clinical manifestations may arise from cerebral or peripheral embolic events or from pulmonary thromboembolism. For this reason, screening echocardiography may be useful, particularly in cases of familial myxoma. Transthoracic and transesophageal echocardiography, combined with careful inspection of all cardiac chambers, play a crucial role in preventing recurrence by detecting small or overlooked tumor fragments. The minimally invasive endoscopic approach offers a safe and effective surgical option for biatrial myxomas, providing excellent visualization and facilitating thorough exploration of the cardiac cavities.

Background/Objectives: Anthracycline-induced cardiotoxicity may compromise cancer treatment and long-term outcomes. Although differences in the cardiotoxicity profile of epirubicin and doxorubicin have been reported, direct comparative pharmacovigilance evidence remains limited. This study compared their cardiovascular adverse reaction reporting profiles using EudraVigilance (EV) data. Methods: Aggregated Individual Case Safety Reports submitted up to 12 July 2026 on the European portal were analyzed. Descriptive analyses assessed demographic characteristics, report origin, reporter type, System Organ Class distribution, seriousness, and clinical outcomes. Cardiotoxicity-related preferred terms (PTs) were identified using the Standardized MedDRA Queries “Cardiac failure”, “Cardiomyopathy”, and “Myocardial infarction”. Comparative disproportionality analysis was restricted to reports submitted by healthcare professionals. Reporting odds ratios and 95% confidence intervals were calculated for PTs with at least five reports for each drug. Results: Overall, 52,257 reports for doxorubicin and 31,049 for epirubicin were identified. Cardiac disorders were reported in 4459 doxorubicin cases and 1406 epirubicin cases, with over 97% classified as serious. Among 51 cardiotoxicity-related PTs, doxorubicin showed significantly higher reporting odds for cardiogenic shock, congestive, chronic, acute, and left ventricular cardiac failure, decreased ejection fraction, cardiomyopathy, cardiotoxicity, toxic cardiomyopathy, acute myocardial infarction, myocardial infarction, and increased troponin. The strongest disproportionality signals were observed for cardiogenic shock, toxic cardiomyopathy, cardiomyopathy, and cardiotoxicity. Conclusions: Doxorubicin was associated with a more pronounced pattern of cardiotoxicity-related reporting and disproportionality signals than epirubicin in the EV database. These findings highlight potential differences in the cardiovascular safety profiles of the two anthracyclines and provide signals that warrant further investigation, while underscoring the importance of cardiovascular risk assessment and monitoring in patients receiving anthracycline therapy. However, disproportionality signals do not establish incidence, absolute risk, or causality and require confirmation in prospective comparative studies.

Background/Objectives: Digoxin, a positive inotropic agent with a narrow therapeutic window, is used in heart failure but carries toxicity risks. This study aims to characterize the profile of digoxin-associated adverse drug reactions reported in the EudraVigilance database, focusing on drug–drug interactions, dosing errors, and off-label use. Methods: Descriptive and disproportionality analyses were performed on Individual Case Safety Reports (ICSRs) until 25 January 2026. Digoxin was compared with other inotropic agents by calculating the Reporting Odds Ratio and 95% confidence intervals. Results: Digoxin recorded 11,426 ICSRs, with a predominance in patients aged 65–85 years (46.4%) and over 85 years (25.1%). Higher reporting probabilities were identified for the terms “Drug interaction” and “Overdose” compared to other inotropes. Fatal outcomes were reported in 19 cases related to drug interactions and 41 cases related to overdose. Consistent disproportionality signals were found for gastrointestinal, renal, and nervous system disorders. Off-label use was reported in 0.8% of cases and was associated with unfavorable clinical outcomes. Risks are exacerbated by polypharmacy and renal decline in elderly patients. Conclusions: Digoxin toxicity and cardiac complications are the primary drivers of reported morbidity. This risk profile highlights the need for the rigorous clinical monitoring, precise dose adjustments and heightened vigilance regarding drug–drug interactions.