Striking Electrocardiographic Changes Associated with Pheochromocytome

Cheng, Tsung O.; Bashour, Tali T.

doi:10.1378/chest.70.3.397

Cited by 57 publications

(32 citation statements)

References 17 publications

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“…The changes include myocardial infarction (Pelkonen and Pitkaenen, 1963;Surawicz and Mangiardi, 1977), T-wave inversion, ST-T changes, alterations of rhythm, and also left ventricular hypertrophy (Williams and Braunwald, 1980). Giant negative T waves with QT prolongation have also been reported (Cheng and Bashour, 1975). The electrocardiographic changes of our patient and most of the reported cases have been reversible (Short and Redfield, 1976;Surawicz and Mangiardi, 1977).…”

Section: Discussionsupporting

confidence: 72%

Unusual cardiovascular manifestations in a case of pheochromocytoma

Sheikhzadeh¹,

Fatourechi²,

Paydar³

et al. 1983

Clinical Cardiology

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Summary:A case of proven pheochromocytoma is reported of a patient who presented with attacks of apparent hypotension, pulmonary edema, and myocardial injury with typical ECG and enzyme change. In spite of unmeasurably low peripheral blood pressure recordings during the attack, central aortic pressure was well above 240/140 mmHg. A clinical shocklike state was in effect due to severe arterial vasoconstriction. The pulmonary artery pressure was 48/26 mmHg during attacks, wedge pressure was 26 mmHg, and cardiac index 1.8 liters/ min/m2. The coronary angiogram showed abnormal pooling of dye in the myocardial capillary network. It is concluded that: (1) Apparent hypotensive episodes in pheochromocytoma may be misleading and central arterial measurements may be needed to demonstrate the hypertensive crisis. (2) The abnormal coronary angiogram in our patient may be due to myocardial necrosis and damage to the intact arteriolar and microvascular system of the myocardium.

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Section: Discussionsupporting

confidence: 72%

Unusual cardiovascular manifestations in a case of pheochromocytoma

Sheikhzadeh¹,

Fatourechi²,

Paydar³

et al. 1983

Clinical Cardiology

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“…Their clinical presentations have varied significantly, from a silent myocardial infarction in one of the first cases reported in the literature 4 , to frank cardiogenic shock 5 . Striking electrocardiographic changes suggesting myocardial ischemia are often present in patients with pheochromocytoma and include marked prolongation of the QT interval, deep and symmetric T wave inversion, and ST segment changes 10 . Although these are very suggestive of myocardial ischemia, they have been described in other conditions such as subarachnoid hemorrhage and the use of certain drugs 10 .…”

Section: Discussionmentioning

confidence: 99%

“…Striking electrocardiographic changes suggesting myocardial ischemia are often present in patients with pheochromocytoma and include marked prolongation of the QT interval, deep and symmetric T wave inversion, and ST segment changes 10 . Although these are very suggestive of myocardial ischemia, they have been described in other conditions such as subarachnoid hemorrhage and the use of certain drugs 10 . None of these situations is likely in the present case.…”

Section: Discussionmentioning

confidence: 99%

Crise de feocromocitoma simulando um infarto agudo do miocárdio em paciente com artérias coronárias normais

Darzé¹,

Sohsten²

2004

Arq. Bras. Cardiol.

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We report a case of pheochromocytoma-induced segmental myocardial dysfunction and electrocardiographic abnormalities mimicking an acute anterior myocardial infarction, probably due to coronary spasm. Coronary angiography showed normal coronaries, and the electrocardiographic and echocardiographic changes resolved completely after therapy with an alpha-adrenergic blocker and tumor removal. Our case illustrates the importance of maintaining a high index of suspicion in patients presenting with an unexpected myocardial event and a hypertensive crisis.Pheochromocytoma is a catecholamine-secreting tumor that arises from chromaffin tissue of the sympathetic nervous system. The usual manifestations of this tumor include palpitations, diaphoresis, headache, and paroxysmal hypertension. In addition to the classic symptoms, pheochromocytomas have been rarely associated with acute myocardial infarction and other cardiovascular complications 1 . We report the case of a patient with an adrenal pheochromocytoma and normal coronary arteries who presented with electrocardiographic and echocardiographic findings consistent with an acute anterolateral myocardial infarction (MI), with complete reversal of these abnormalities after alpha-adrenergic treatment. Case ReportA 46-year-old female with history of hypertension was hospitalized with nausea, vomiting, and diaphoresis for 2 days. On physical examination, her initial blood pressure was 230/130 mmHg; heart rate, 132 bpm; and her skin was mottled. The rest of the examination was unremarkable. The electrocardiogram ( fig. 1) showed sinus tachycardia with ST segment elevation and deep, symmetric T wave inversion in leads V2 thru V6. The T waves were also inverted in leads I, aVL, II, and aVF. The QT interval was markedly prolonged and Q waves were present in leads II, III, aVF.She was taken to the cardiac catheterization laboratory where a coronary angiogram showed no significant coronary disease. The left ventriculogram ( fig. 2) showed severe anterolateral and apical hypokinesis. During the procedure, the patient required mechanical ventilation, and the arterial blood pressure became very labile, going from as high as 320/240 mmHg to as low as 70/30 mmHg, warranting the use of vasodilators and, at times, vasopressors. The diagnosis of pheochromocytoma was suspected, and therapy with an alpha-adrenergic blocker was started, which slowly controlled the blood pressure.Laboratory data included 24-hour urinary vanillylmandelic acid, metanephrine, epinephrine, and norepinephrine levels that were, respectively, 313 mg (normal, 2-10), 76 (normal, 0.3-0.9), 12339 ng (normal, 0-16), and 28316 ng (normal, 11-86). The blood urea nitrogen was 26 mg/dL and creatinine was 2.0 mg/dL. The peak CPK level was 951 IU/L with a normal MB fraction. A computed tomography revealed a rounded mass in the left adrenal gland.Blood pressure returned to normal within 5 days of therapy with an intravenous alpha-adrenergic blocker. The patient was extubated, and renal function normalized. Serial echocardiogram...

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“…Tümör taraf›ndan salg›lanan vazoaktif maddelerden olan adrenomedullin ve nöropeptit-y bafl a¤r›s›na sebep olmaktad›r (6,7). Feokromositomalar serebral kanama, serebral infarkt, multiorgan yetmezli¤i, akut miyokart enfarktüsü, kardiyak aritmi, konjestif kalp yermezli¤i, ba¤›rsaklarda iskemik kangren gibi ölümcül olabilen birtak›m sonuç-larla da karfl›m›za ç›kabilir (8,9,10). ‹drarda vanilmandeleik asit, metanefrin gibi katekolamin türevlerinin tespiti ve BT veya MR ile tümörün lokalizasyonun gösteril-mesi ile tan›s› konur (11,12).…”

Section: G‹r‹fiunclassified

Feokromositoma Serebral Kanamaya Bağlı Ani Ölüm

et al. 2005

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K›r Z, Pakifl I, Özaslan A, Özbay M. Feokromositoma: Serebral kanamaya ba¤l› ani ölüm. Adli T›p Bülteni, 2005;10(3):96-99. Feokromositoma; fliddetli hipertansiyon ve buna efllik eden serebral, kardiyak, renal komplikasyonlar, hipotansiyon, flok ve hatta ölüme yol açabilen endokrin bir tümördür. Feokromositomal› hastalar›n ço¤undan klinik olarak flüphele-nilmez. Tümörün ölümcül sonuçlar› da tan›daki bu gecikmeye ba¤l› olarak ortaya ç›kar.Uzun zamandan beri bafl a¤r›s› flikâyeti olan ve bu nedenle a¤r› kesici kullanm›fl ancak ileri tetkikler yapt›rmam›fl 17 yafl›n-daki k›z olgu, ani ölüm tablosu ile kaybedilmifltir. Olgunun Adli T›p Kurumu Morg ‹htisas Dairesi'nde yap›lan otopsisinde feokromositoma ve beyinde ventrikül içinde kanama saptanm›fl-t›r. Bu olgu bize tan› konulmam›fl feokromositomalar›n ölümcül sonuçlanabilece¤ini göstermesi aç›s›ndan önemlidir.Anahtar kelimeler: Feokromositoma, ölüm, otopsi SUMMARYPheochromocytoma is an endocrine tumor characterized by severe hypertension associated with cerebral, cardiac, and renal complications, hypotension or even shock and sudden death. Most pheochromocytoma cases remain obscene clinically, fatal outcome is mostly related with such misdiagnosis.A 17-year-old girl with a history of chronic headache who had not been evaluated clinically died unexpectedly. The autopsy performed in the mortuary section of the council of forensic medicine revealed a pheochromocytoma and intraventricular cerebral bleeding. This case accentuates that pheochromocytomas, if remaining undiagnosed, may prove fatal.

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Striking Electrocardiographic Changes Associated with Pheochromocytome

Cited by 57 publications

References 17 publications

Unusual cardiovascular manifestations in a case of pheochromocytoma

Unusual cardiovascular manifestations in a case of pheochromocytoma

Crise de feocromocitoma simulando um infarto agudo do miocárdio em paciente com artérias coronárias normais

Feokromositoma Serebral Kanamaya Bağlı Ani Ölüm

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