Miocardite aguda secundaria a feocromocitoma

Abstract

She reported that 1 month earlier, these symptoms got worse, coinciding with her job loss and the end of a long-term relationship. She reported being used to moderate and regular physical activity, without problem. Five years earlier, the patient had been diagnosed with mild and labile hypertension, evidenced as occipital headache during physical activity. Since then, she has been on regular use of 25 mg of atenolol and 12.5 mg per day of hydrochlorothiazide, achieving excellent blood pressure control. On the same occasion, a rectification of the mitral valve with escape was diagnosed on the echocardiogram. On her biannual follow-ups, no target-organ lesion was evidenced. She reported smoking since 1999 and also an important familial history of hypertension, including both parents, with a significant "white-coat" effect. On physical examination, her radial pulse (RP) was 64 bpm, regular, and full, and her blood pressure was 154/88 mmHg (mean of 2 measurements). Ambulatory blood pressure monitoring, Holter monitoring, and exercise testing were normal. Her glycemia was 128 mg/dL, and her urinalysis showed 5 pyocytes per field. She was using Tenoretic (25 mg/morning), and atenolol (25 mg every night) was added. The patient improved with an increase in the dosage of atenolol, but, 1 month after the first medical visit, and after her usual physical activity, she experienced intense malaise, accompanied by tachycardia, sweating, pallor, and epigastric pain followed by lipothymia, being then referred to the emergency unit. She began to complain of high abdominal band-like pain, nausea, and frequent vomiting. Her RP was 92 bpm, weak, and her BP was 156/ 75 mmHg. She underwent ultrasonography of the total abdomen, 2 electrocardiographies, and measurement of amylase and cardiac, hepatic, and muscle enzymes, which were within the normal range. Her leukogram showed 28,000 leukocytes, and no eosinophils. The patient was referred to a general hospital, and, at the end of the day, her troponin was 9 ncg/dL, and later, 10. Her leukocyte count remained elevated and the leukogram maintained with the same pattern. She began to have mild hypotension. Two more electrocardiographies were performed, but were normal. The echocardiography revealed chambers of normal dimensions, akinesia of all myocardial segments, except for the apical segments, which were hyperkinetic, important systolic dysfunction, and moderate pulmonary hypertension. Acute heart disease, probably of viral origin, was suspected. Treatment for ventricular dysfunction (25 mg of captopril, BID; and 40 mg/day of furosemide) was initiated, with an excellent response. Gallium-67 myocardial scintigraphy was performed to confirm the diagnosis of viral myocarditis.The complaints disappeared and the hemodynamic findings became stable. On the third day of hospitalization, the patient developed arrhythmias, such as atrial fibrillation, paroxysmal atrial

Achado incidental de feocromocitoma após exame de imagem

“…12,13 Em geral, a sintomatologia é ampla, estando a hipertensão arterial presente em entre 50 e 90% dos casos, porém 8% dos pacientes podem apresentar sintomas brandos ou ser assintomáticos. 6,14 Chama a atenção a pobreza de sintomatologia manifestada pela mulher considerada neste estudo, uma vez que apresentou apenas hipertensão arterial. Ela não sabia ser portadora de tal condição.…”

“…Outros sintomas que podem estar associados são tremor, palidez, náusea, perda de peso e dor torácica ou abdominal. 6,7 Os níveis de catecolaminas circulantes nem sempre se correlacionam com os de tensão arterial, podendo o paciente apresentar-se normotenso, hipertenso ou mesmo com episódios de hipotensão ortostática. 8 Os paroxismos (exacerbações/crises) estão presentes em de 10 a 17% dos pacientes com feocromocitoma como reflexo da secreção excessiva de epinefrina e dopamina.…”