Pheochromocytoma mimicking an acute myocardial infarction

Abstract

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.).

Perioperative management of a large, late presenting phaeochromocytoma

“…Similar to our patient, none had any evidence of coronary artery occlusion on angiogram 19–23. This is in keeping with the current theory of intense coronary vasospasm caused by direct toxic effects of catecholamines 24. This would have resolved by the time the patient underwent an angiogram and would explain the negative findings on angiogram with these cases.…”

Thrombus in a Normal Left Ventricle: A Cardiac Manifestation of Pheochromocytoma

“…During a pheochromocytoma crisis, a myocardial demand‐supply mismatch can also occur due to catecholamine‐driven increased afterload (vasoconstriction), tachycardia, and coronary vasospasm 5 . This may result in transient myocardial ischemia, evidenced in our patient by ECG abnormalities and increased troponin‐T levels.…”

Pheochromocytoma Presenting as Acute Severe Congestive Heart Failure, Dilated Cardiomyopathy, and Severe Mitral Valvular Regurgitation: A Case Report and Review of the Literature

“…20,21 Although it is rare, myocardial involvement other than sustained or paroxysmal hypertension, from a pheochromocytoma can include angina pectoris, acute heart failure, dilated cardiomyopathy, myocardial infarction, and arrhythmias. [22][23][24][25][26] The acute onset of severe congestive heart failure secondary to catecholamine overproduction from a pheochromocytoma is a rare entity, especially when few or none of the other classic signs or symptoms are present. Our patient presented in such a manner, and if not for abdominal distention prompting evaluation with helical CT and subsequent finding of a right adrenal mass, the differential diagnosis of a pheochromocytoma may not have been entertained as quickly.…”