Unusual cardiovascular manifestations in a case of pheochromocytoma

Abstract

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.

Pheochromocytoma crisis precipitated by dexamethasone with profound lactic acidosis, but without severe hypertension

“…One case reported difficulty palpating peripheral pulses or obtaining noninvasive blood pressure readings in a setting of apparent hypotension, pulmonary edema, and evidence of myocardial injury. However, a central aortic pressure as high as 320/200 mmHg was documented, demonstrating that the patient's ‘shock’ was in fact a hypertensive crisis due to severe arterial vasoconstriction ( 2 ).…”

Hepatitis C‐associated cryoglobulinaemia presenting with refractory hypertensive crisis and acute pulmonary oedema

“…Hypertensive crisis with rapid‐onset pulmonary oedema has been associated with coronary artery disease, 2 renal artery stenosis 3 , 4 and phaeochromocytoma, 5 but a search of English‐language articles in PubMed revealed no previous reports of an association with mixed cryoglobulinaemia. The latter is characterised by the presence of cold‐precipitable cryoglobulins in serum.…”

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

“…Pheochromocytoma-induced myocardial disease may take the form of ventricular hypertrophy due to long-standing hypertension 2 , dilated cardiomyopathy because of persistent and prolonged exposure to high levels of catecholamines 3 , or, r arely, it may mimic an acute myocardial infarction [4][5][6][7][8][9] . We report the case of a rare association between pheochromocytoma and reversible myocardial dysfunction in a patient with normal coronaries.…”

“…The pathophysiology of myocardial dysfunction associated with pheochromocytoma has been linked to either a direct toxic effect induced by catecholamines 3 , or myocardial stunning caused by coronary spasm 9 . These changes along with the ECG abnormalities are commonly reversible after treatment with alpha-adrenergic blockers and tumor removal 5,7 .…”