Ventricular Rhythm and Hypotension in a Patient with Pheochromocytoma-induced Myocardial Damage and Reverse Takotsubo Cardiomyopathy

Tagawa, Minoru; Nanba, Hitomi; Suzuki, Hiromi; Nakamura, Yūichi; Uchiyama, Hiroko; Ochiai, Shun; Terunuma, Masahiro; Yahata, Kazuaki; Minamino, Tohru

doi:10.2169/internalmedicine.54.4732

Cited by 6 publications

(10 citation statements)

References 18 publications

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“…It has been reported that patients can present with transient reversible cardiomyopathy in Takotsubo or diffuse hypokinesia pattern [ 8 ]. Similar to our case, Tagawa et al reported a case of a young lady who presented with reverse Takotsubo cardiomyopathy and ventricular arrhythmia secondary to pheochromocytoma [ 9 ]. However, it was her first presentation at that time.…”

Section: Discussionsupporting

confidence: 86%

Cardiogenic Shock With Reverse Takotsubo Pattern Secondary to Pheochromocytoma: A Case Report

Trongtorsak¹,

Chaisidhivej²,

Kewcharoen³

et al. 2021

Cureus

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Pheochromocytoma is a rare catecholamine-secreting neuroendocrine tumor arising from chromaffin cells. Acute catecholamine-mediated cardiomyopathy secondary to pheochromocytoma is rare, but life-threatening. We report a case of a 50-year-old man who presented with chest pain with electrocardiography showing ST elevation in V2-4. He was transferred to cardiac catheterization laboratory for coronary angiography immediately. However, the results showed no evidence of coronary artery occlusions and the left ventriculography revealed hypokinesia of basal part with poor left ventricular ejection fraction. Further investigation confirmed pheochromocytoma-related reversible cardiomyopathy.

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Section: Discussionsupporting

confidence: 86%

Cardiogenic Shock With Reverse Takotsubo Pattern Secondary to Pheochromocytoma: A Case Report

Trongtorsak¹,

Chaisidhivej²,

Kewcharoen³

et al. 2021

Cureus

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“…Takotsubo-like CMP presents often with acute chest pain, occasionally with symptoms of heart failure and most commonly with S-T segment changes mimicking acute coronary syndrome, accompanied with regional LV dysfunction and mildly abnormal cardiac biomarkers [9,[50][51][52]. It is an acute, reversible condition, which involves a stress-or neuroendocrine-mediated process with distinct echocardiographic findings of apical ballooning (contractile dysfunction most prominent at the apex) and hypercontractility at the base of the left ventricle.…”

Section: Takotsubo Cardiomyopathy (Tcm)mentioning

confidence: 99%

“…The ejection fraction of all patients included was very severe (median LVEF 15 %). Of the 34 who were placed on VA-ECMO, all survived except for two patients [52].…”

Section: Therapeutic Management Of Cicmppmentioning

confidence: 99%

Catecholamine-Induced Cardiomyopathy in Pheochromocytoma: How to Manage a Rare Complication in a Rare Disease?

et al. 2018

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Pheochromocytomas and paragangliomas (PHEOs) are rare neuroendocrine tumors. Clinical manifestations include different cardiovascular signs and symptoms, which are related to excessive secretion of catecholamines. Catecholamine-induced cardiomyopathy in PHEO (CICMPP) is a rare but dreaded complication of PHEO. Once patient is diagnosed with this condition, the prognosis is worse and a surgical risk is much higher than expected. This article focuses on how catecholamines affect the heart and the pathophysiologic mechanism of CICMPP. The cardiovascular responses to catecholamine depend mostly on which catecholamine is released as well as the amount of catecholamine that is released. The acute release of norepinephrine and epinephrine from PHEO increases heart rate, systemic vascular resistance, myocardial contractility, and reduces venous compliance. The excessive adrenergic stimulation by catecholamine results in severe vasoconstriction and coronary vasospasm, myocardial ischemia, and subsequently damage, and necrosis. Chronically elevated catecholamine levels lead to significant desensitization of cardiac β-adrenoceptors. The increased levels of the enzyme β-adrenoceptors kinase (βARK) in the heart seems to mediate these biochemical and physiological changes that are consistently correlated with attenuated responsiveness to catecholamine stimulation. Through these mechanisms different types of cardiomyopathy (CMP) can be formed. This review discusses extensively the 3 types of cardiomyopathies that can be present in a PHEO patient. It also provides the clinical presentation and diagnostic and therapeutic algorithm in managing patients with CICMPP.

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“…It has been suggested that inodilators, such as milrinone and levosimendan, which act through nonadrenergic pathways, could be good alternatives to provide inotropic support and relieve afterload. Although the European Society of Cardiology guidelines do not recommend milrinone in the treatment of Takotsubo cardiomyopathy, there are multiple PPGL cases described in the literature in which it has been successfully used, including one of our hypotensive patients [26][27][28][29][30].…”

Section: Discussionmentioning

confidence: 99%

Pheochromocytoma/paraganglioma crisis: case series from a tertiary referral center for pheochromocytomas and paragangliomas

2021

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Pheochromocytoma/paraganglioma (PPGL)-induced catecholamine crisis is a rare endocrine emergency leading to life-threatening hemodynamic instability causing end-organ damage or dysfunction. As it is associated with a significant mortality rate of approximately 15%, recognizing the signs and symptoms and making the appropriate diagnosis are critical. For this purpose, we report the clinical course of the crisis in four out of a total of six patients with a PPGL crisis from a cohort of 199 PPGL patients of a single tertiary referral center for PPGL patients in the Netherlands diagnosed between 2002 and 2020. Successful treatment of a PPGL crisis demands prompt diagnosis, vigorous pharmacological therapy, and emergency tumor removal if the patient continues to deteriorate.

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Ventricular Rhythm and Hypotension in a Patient with Pheochromocytoma-induced Myocardial Damage and Reverse Takotsubo Cardiomyopathy

Cited by 6 publications

References 18 publications

Cardiogenic Shock With Reverse Takotsubo Pattern Secondary to Pheochromocytoma: A Case Report

Cardiogenic Shock With Reverse Takotsubo Pattern Secondary to Pheochromocytoma: A Case Report

Catecholamine-Induced Cardiomyopathy in Pheochromocytoma: How to Manage a Rare Complication in a Rare Disease?

Pheochromocytoma/paraganglioma crisis: case series from a tertiary referral center for pheochromocytomas and paragangliomas

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