Pheochromocytoma and Myocardial Infarction

Garg, Akash; Banitt, Peter F.

doi:10.1097/01.smj.0000141310.27872.84

Cited by 18 publications

(15 citation statements)

References 12 publications

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“…[3][4][5][6][7] During a pheochromocytoma crisis, a myocardial oxygen demand-supply mismatch can occur due to an increased afterload (vasoconstriction), catecholaminedriven tachycardia, and catecholamine-driven coronary vasospasms. This can precipitate myocardial ischaemia with concomitant electrocardiographic abnormalities, even in the absence of coronary atherosclerosis.…”

Section: Discussionmentioning

confidence: 99%

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Pheochromocytoma mimicking an acute myocardial infarction

Oordt

Twickler²,

Asperdt³

et al. 2007

NHJL

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We report a 42-year-old female who presented with retrosternal pain, dyspnoea and nausea. Electrocardiography suggested a recent anterior myocardial infarction. However, emergency coronary angiography showed normal blood flow through all the coronary arteries. Paroxysmal hypertension raised the suspicion of a pheochromocytoma. Indeed, abdominal ultrasonography and computed tomography revealed a mass in the left adrenal gland. Elevated levels of plasma and urine catecholamines supported the diagnosis of pheochromocytoma. Left adrenalectomy was performed without complications and pathological examination revealed a 5.5 cm pheochromocytoma. After surgery, all antihypertensive medication was discontinued and the blood pressure returned to normal within several days. Currently, the patient is asymptomatic, has normal catecholamine levels and the electrocardiographic signs of ischaemia have resolved entirely. This case illustrates that a rare clinical entity such as pheochromocytoma should be considered in the differential diagnosis of acute coronary syndrome. (Neth Heart J 2007;15:248-51.).

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Section: Discussionmentioning

confidence: 99%

“…1,2 However, pheochromocytoma rarely presents as acute coronary syndrome. [3][4][5][6][7] In this case report, we describe a young female who presented with retrosternal pain and electrocardiographic changes suggestive of acute myocardial ischaemia. Finally, a pheochromocytoma was diagnosed.…”

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confidence: 99%

Pheochromocytoma mimicking an acute myocardial infarction

Oordt

Twickler²,

Asperdt³

et al. 2007

NHJL

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“…Reversible myocardial dysfunction and signs similar to myocardial infarction are known to occur with pheochromocytoma. [1][2][3][4][5][6][7][8][9][10][11][12] Various etiologies have been proposed including vasospasm from excessive catecholamine levels, myocardial dysfunction from the direct effect of catecholamines, and myocardial ischemia because of increased oxygen consumption. These cardiac symptoms improve following excision of the pheochromocytoma, something we observed in our case as the patient's electrocardiogram abnormalities, troponin I level, and decrease in cardiac function improved after the tumor was excised.…”

Section: Discussionmentioning

confidence: 99%

Multiple Cerebral Infarction and Cardiomyopathy With Pheochromocytoma

Ueda

Satoh²,

Kuroiwa

2011

The Neurologist

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A 44-year-old woman was admitted to our hospital with altered mental status and weakness in the left upper and lower limbs. A brain magnetic resonance imaging indicated multiple cerebral infarctions in the bilateral frontal and parietal lobes and in the left occipital lobe. Magnetic resonance angiography indicated overall arterial wall irregularity and stenosis. An electrocardiogram showed negative T waves, troponin I was elevated at 0.60 ng/mL, and an echocardiogram showed severe hypokinesis, leading to a diagnosis of ischemic heart disease; however, no stenosis was found at cardiac catheterization. No other etiology for the angiopathy could be found. Whole-body computed tomography demonstrated an adrenal tumor and urinary catecholamine levels were elevated. Following excision of the adrenal tumor, a diagnosis of pheochromocytoma was made. Postoperatively, the patient's arterial stenosis and cardiac abnormalities improved. It was hypothesized that the patient's cardiomyopathy and vasospasm were secondary to excessive catecholamine secretion from the pheochromocytoma.

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“…Our patients were stabilised for 6-8 weeks prior to surgery, largely because they were referred from secondary centres, where treatment with phenoxybenzamine had been initiated. In other series, patients have received alpha-blockers for 10-21 days prior to surgery [19][20][21][22][23][24][25][26].…”

Section: Discussionmentioning

confidence: 99%

“…Combined -CABG followed by phaeochromocytoma excision [19-22, 24, 26] Staged -CABG then delayed phaeochromocytoma excision [23,25] Staged -phaeochromocytoma excision then delayed CABG [27] nil †Protamine administration was not mentioned in one of the case reports [21]. N ⁄ A, not applicable.…”

Section: Discussionmentioning

confidence: 99%

Combined coronary artery bypass grafting and phaeochromocytoma excision

To¹,

Frost²,

Grey³

et al. 2007

Anaesthesia

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SummaryWe report two patients who had successful combined coronary artery bypass grafting and excision of phaeochromocytoma. These cases represent the first reports of combined coronary artery bypass grafting and laparoscopic adrenalectomy for phaeochromocytoma and of combined coronary artery bypass grafting and excision of extra-adrenal phaeochromocytoma. With careful peri-and intra-operative management, especially in regard to haemostasis, combined operations for coronary artery disease and phaeochromocytoma are both feasible and safe. Phaeochromocytoma requires careful pre-and intraoperative control of blood pressure to prevent vascular instability induced by unpredictable catecholamine release. It is associated with important risk factors for ischaemic heart disease, such as hypertension, glucose intolerance, hypercholesterolaemia and enhanced coagulation [1], which contribute to the accelerated development of atherosclerosis [2]. Patients with co-existent phaeochromocytoma and coronary artery disease requiring surgical revascularisation are rare, but pose a significant management problem for physicians, surgeons and anaesthetists, in particular with respect to the timing of coronary artery bypass grafting (CABG) and adrenalectomy. We report two cases of phaeochromocytoma with severe coronary artery disease diagnosed during the pre-operative work-up for phaeochromocytoma excision. Both patients were managed successfully with combined CABG and tumour excision, in the first case by laparoscopic adrenalectomy and in the second by laparotomy for a retroperitoneal paraganglioma. Case report 1A 76-year-old female non-smoker with a history of hypercholesterolaemia, hypothyroidism and autoimmune haemolytic anaemia, presented with episodic diaphoresis and nausea for 2 years, worse over the preceding 5 months. She had mild angina and a progressive reduction in exercise tolerance to one flight of stairs, but denied palpitations or symptoms of heart failure. The differential diagnosis included phaeochromocytoma and the patient underwent computed tomography (CT) of the abdomen, where a 4-cm right adrenal mass was found and confirmed to be a phaeochromocytoma by urinary catecholamine assays (adrenaline 1.57 mmol.day )1 (< 0.10), noradrenaline 1.85 lmol.day )1 (< 0.76)). Treatment with phenoxybenzamine was commenced. In view of her cardiac symptoms, she underwent an exercise ECG which was positive and coronary angiography demonstrated severe three vessel disease with normal left ventricular function. Six weeks after the initial diagnosis she proceeded to surgery. At this time she was receiving total daily doses of phenoxybenzamine 120 mg, metoprolol succinate 47.5 mg, simvastatin 40 mg and aspirin 100 mg. Her pre-operative blood pressure was 140 ⁄ 72 mmHg lying and 130 ⁄ 64 mmHg standing, with a heart rate of 65 beats.min )1. After premedication with oral midazolam and radial arterial line insertion, anaesthesia was induced with fentanyl and etomidate, and tracheal intubation was facilitated with rocuronium. Anaesthesia wa...

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Pheochromocytoma and Myocardial Infarction

Cited by 18 publications

References 12 publications

Pheochromocytoma mimicking an acute myocardial infarction

Pheochromocytoma mimicking an acute myocardial infarction

Multiple Cerebral Infarction and Cardiomyopathy With Pheochromocytoma

Combined coronary artery bypass grafting and phaeochromocytoma excision

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