A complicated case of myocardial infarction with nonobstructive coronary arteries with an underlying pheochromocytoma: a case report

Abstract

Background The signs and symptoms of pheochromocytoma can imitate those of many other diseases, which may result in confusion. Therefore, diagnosing and treating secondary hypertension due to pheochromocytoma in deteriorating patients becomes challenging. Case presentation A 63-year-old female patient presented to the emergency room with severe and progressive nausea. The initial diagnosis was an acute myocardial infarction based on ST-segment depression on electrocardiogram and elevated cardiac markers. Elective coronary angiography revealed nonobstructive coronary arteries. However, she suffered from a complicated clinical course for several weeks during her life-or-death crisis. She was subsequently diagnosed with a cerebral hemorrhage and a pheochromocytoma. It is unclear whether her initial presentation was due to the neurogenic stunned myocardium caused by a cerebral hemorrhage or type 2 myocardial infarction caused by a pheochromocytoma, or both. However, this case showed the significance of accurately diagnosing and treating underlying causes in patients presenting with myocardial infarction with nonobstructive coronary arteries. Early diagnosis and treatment of the pheochromocytoma may have prevented the complications experienced by the patient. Conclusions A catecholamine surge and blood pressure fluctuation caused severe complications. When a patient presents with an unusual clinical presentation, secondary hypertension due to pheochromocytoma should be suspected.

Acute Complications in Patients with Myocardial Infarction with Non-Obstructive Coronary Arteries: A Systematic Review with Special Focus on Mechanical Complications

“…Jung et al . [ 30 ] reported intracerebral hemorrhage, and Kissami et al . [ 31 ] reported intestinal bleeding.…”

“…We also identified that bleeding complications linked to dual antiplatelet therapy or heparin treatment is also a problem in MINOCA patients. There are cases showing gastrointestinal as well as intracerebral hemorrhage events [ 30 , 31 ].…”

“…In the literature search, we also identified papers showing complications not associated directly with MINOCA pathomechanism, but rather with MINOCA management. Jung et al [30] reported intracerebral hemorrhage, and Kissami et al [31] reported intestinal bleeding. Both could have been related to dual antiplatelet therapy and heparin treatment.…”

Myocardial Infarction With Non-obstructive Coronary Arteries: An Updated Overview of Pathophysiology, Diagnosis, and Management

“…NSTEMI-MINOCA presentations make up a significant proportion of all MINOCA cases. According to studies, patients with NSTEMI-MINOCA appeared more frequently than STEMI-MINOCA [ 2 , 29 - 30 ]. Angiographic criteria include the absence of obstructive disease on angiography (i.e., no coronary artery stenosis ≥50%) in any major epicardial vessel.…”