The evaluation of a patient suspected of having an atrial myxoma is based initially on a unique association of physical findings and symptoms referrable to obstructive, embolic, and/or constitutional manifestations of the tumor. Objective confirmation is sought with the use of M-mode and 2D echocardiography. A nondiagnostic echocardiogram, especially with recurrent or progressive symptoms and signs of atrial myxoma, should prompt more invasive methods of confirmation. The hemodynamic and angiographic data previously discussed may provide the clues needed for diagnosis, especially with nonprolapsing myxomas. The use of other techniques, such as a gated blood pool scanning or computerized tomography, affects primarily the incidental discovery of a "silent" tumor. Urgent surgical removal of the myxoma is mandatory to avoid progressive obstructive and embolic complications. Postoperative examination should be directed specifically at evaluating the patient for intracardiac tumor recurrence or growth of a peripheral embolic fragment. The incidence of these complications is small, but they are frequently overlooked. A second echocardiogram should be obtained as an initial baseline study. The asymptomatic patient should have subsequent routine clinical examinations to detect the growth of tumor embolic fragments and an echocardiographic examination every year or two to detect intracardiac tumor recurrence. Immediate evaluation is necessary should the patient develop recurrent symptoms.