Pheochromocytoma Presenting with Takotsubo Syndrome

Marcovitz, Pamela A.; Czako, Peter; Rosenblatt, Solomon; Billecke, Scott S.

doi:10.1111/j.1540-8183.2010.00551.x

Cited by 42 publications

(25 citation statements)

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“…Plasma catecholamine concentrations at the time of onset were increased in patients with sCMP when compared to patients with myocardial infarction [9]. Exogenous administration of catecholamines and pheochromocytoma have been reported to cause typical features of sCMP adding more evidence to this theory [10,11]. During stressful conditions, the sympathetic nervous system is activated, and this may influence myocardial contraction.…”

Section: Discussionmentioning

confidence: 99%

Clinical features of patients with stress-induced cardiomyopathy associated with renal dysfunction: 7 case series in single center

et al. 2013

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BackgroundStress-induced cardiomyopathy (sCMP) is characterized by transient wall-motion abnormalities involving the left ventricular apex and mid-ventricle that are precipitated by emotional or physical stress. As the heart and kidney influence each other’s function through bidirectional pathways, sCMP can induce renal dysfunction or be induced by renal dysfunction. This study reviewed the clinical characteristics and outcomes of patients with confirmed sCMP associated with renal dysfunction.MethodsWe conducted a retrospective analysis of the medical records of all patients from our institution who were diagnosed with sCMP from March 2010 to April 2012. Each patient’s demographic characteristics, presenting symptoms, triggering events, electrocardiographic characteristics, laboratory data, echocardiographic study findings, cardiac catheterization data, and outcomes were reviewed.ResultsAmong 30 patients who were diagnosed with sCMP, 7 patients had associated renal dysfunction. Three patients were on maintenance hemodialysis (HD) and 4 patients had acute kidney injury (AKI). Their mean ejection fraction was 35.2% at initial echocardiography, and 57.2% at follow-up echocardiography. Pericardial effusion was detected in all HD patients initially; these patients were treated with intensive HD for suspected under-dialysis status. In patients with AKI, the mean peak serum creatinine was 4.17 mg/dL. Two patients were treated with continuous renal replacement therapy. One patient required maintenance HD, and 1 patient died. Two patients had full renal recovery to their baseline renal function at 7 and 14 days.ConclusionsPatients with renal dysfunction including those with AKI and those undergoing HD can develop sCMP, renal function must be closely monitored in patients with sCMP. Additionally, it should be considered that patients on HD who develop sCMP may be under-dialyzed.

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Section: Discussionmentioning

confidence: 99%

Clinical features of patients with stress-induced cardiomyopathy associated with renal dysfunction: 7 case series in single center

et al. 2013

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“…Wittstein et al have found serum catecholamine concentration to be 2–3 times higher in takotsubo cardiomyopathy patients than in patients with Killip class III myocardial infarction and argued that severe emotional stress acts as a precipitant 35. Exogenous administration of catecholamines (epinephrine or dobutamine) and phaeochromocytoma have been reported to cause typical features of takotsubo cardiomyopathy adding more evidence to this theory 36 37. However, the exact mechanisms of LV wall dysfunction are complex and are thought to involve myocytes and their metabolism, microvasculature and oxidative stress.…”

Section: Clinical Featuresmentioning

confidence: 99%

Takotsubo cardiomyopathy: pathophysiology and treatment

Milinis

Fisher

2012

Postgraduate Medical Journal

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Since it was first described 20 years ago in Japan, takotsubo cardiomyopathy has received considerable interest from the medical community around the world, particularly in recent years. Although takotsubo cardiomyopathy was originally described as a transient, stress-induced dysfunction of the left ventricular apex, other morphological subtypes have now been described. The pathogenesis of this disorder is likely to be catecholamine mediated myocyte damage and microvascular dysfunction; however, a number of possible alternative theories have been suggested. These include oxidative stress, transient coronary obstruction and oestrogen deficiency, the last explaining the high prevalence of takotsubo cardiomyopathy in women. The treatment remains largely supportive; however, a number of agents have been implicated in the acute stage and long term. Although most of the patients show complete recovery, there is a high risk of complications at the initial presentation requiring intense support.

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“…1,2 This syndrome usually affects postmenopausal women and is precipitated by physical stress, psychological triggers, or other states of adrenergic overstimulation such as administration of catecholamines, abrupt withdrawal of psychotropic drugs, and uncontrolled pain. [3][4][5][6] Affected patients usually survive, showing restoration of previous cardiovascular status with electrocardiographic (ECG) normalization and recovery of ventricular function within approximately 1 month. 1 Based on the regional distribution of LV dysfunction, the following variants of TTC have been described: 1 "typical" (akinesia of the mid-apical LV segments) and 3 "atypical," that is, "mid-ventricular" (akinesia of the mid-LV segments), "reverse" (wall motion abnormalities confined to the basal/ mid LV segments), and "localized" to specific LV areas.…”

Section: Introductionmentioning

confidence: 99%