Ventricular Tachycardia and Resembling Acute Coronary Syndrome During Pheochromocytoma Crisis

Abstract

Pheochromocytomas are neuroendocrine tumors, and its cardiac involvement may include transient myocardial dysfunction, acute coronary syndrome (ACS), and even ventricular arrhythmias.A patient was referred for evaluation of stuttering chest pain, and his electrocardiogram showed T-wave inversion over leads V1 to V4. Coronary angiography showed 90% stenosis in the mid-left anterior descending coronary artery (LAD), which was stented. Five days later, the patient had ventricular tachycardia, and severe hypertension, remarkable blood pressure fluctuation between 224/76 and 70/50 mm Hg. The patient felt abdominal pain and his abdominal ultrasound showed suspicious right adrenal gland tumor. Enhanced computed tomography of adrenal gland conformed that there was a tumor in right adrenal gland accompanied by an upset level of aldosterone.The tumor was removed by laparoscope, and the pathological examination showed pheochromocytoma. After the surgery, the blood pressure turned normal gradually. There was no T-wave inversion in lead V1-V4. Our case illustrates a rare pheochromocytoma presentation with a VT and resembling ACS. In our case, the serious stenosis in the mid of LAD could be explained by worsen the clinical course of myocardial ischemia or severe coronary vasospasm by the excessive amounts of catecholamines released from the tumor. Coronary vasospasm was possible because he had no classic coronary risk factors (e.g. family history and smoking habit, essential hypertension, hyperglycemia and abnormal serum lipoprotein, high body mass index). Thus, pheochromocytoma was missed until he revealed the association of his symptoms with abdominalgia.As phaeochromocytomas that present with cardiovascular complications can be fatal, it is necessary to screen for the disease when patients present with symptoms indicating catecholamine excess.

Comparison of Single Culture and the Consortium of Growth-Promoting Rhizobacteria from Three Tomato (Lycopersicon esculentum Mill) Varieties

“…They are due to the secretion of norepinephrine by pheochromocytoma. When betaadrenoceptors are stimulated by excess catecholamine, they can lead to sinus tachycardia, atrial tachyarrhythmia as in our case [5] or even ventricular tachycardias [12], and in rare cases sinus dysfunction [13]. Atrioventricular dissociation was associated with pheochromocytoma in only 2 cases [11].…”

Myelofibrosis Associated, with Rickets, is it Hyperparathyroidism the Triggering Agent or Vitamin D and Hypocalcemia or Hypophosphatemia?

“…It is essential to identify patients with pheochromocytoma as undetected tumors may cause severe life-threatening condition i.e. heart attack, brain ischemia, arrhythmias, kidney failure, dissecting aorta aneurism or irreversible shock [3][4][5]. Conditions, which should be considered in differential diagnosis include: essential hypertension, anxiety attack, hyperthyroidism, hypogonadism, hypoglycemia, renal artery stenosis, intracranial lesion, autonomic epilepsy, carcinoid syndrome, use of cocaine or amphetamine [1,6].…”

Recurrence of non-cardiogenic pulmonary edema and sustained hypotension shock in cystic pheochromocytoma

“…The mechanism of pheochromocytoma-induced myocardial injury is catecholamine excess, including catecholamine-related hemodynamic instability and catecholamine-mediated cardiomyocyte toxic effect (Prejbisz et al, 2011;Li et al, 2016). From this case, we know that chest pain, sweating, and dysphoria may be the only syndromes of pheochromocytoma crisis, so pheochromocytoma should be considered when the diagnosis is difficult.…”