Abstract
Background. A 27-year-old male presented with exercise-related symptoms of chest tightness, palpitations, breathlessness and severe headache, with occasional nausea, dizziness, and blurred vision. Apart from a family history of coronary artery disease there was no other medical history of note.
Investigations. Clinical examination, treadmill exercise test (Bruce protocol), electrocardiography, MRI of the abdomen, blood tests, chest radiography, coronary angiography, two-dimensional echocardiography, transesophageal echocardiography, microscopy of the tumor, 131iodine metaiodobenzylguanidine scan.
Diagnosis. Pheochromocytoma myocarditis.
Management. Intra-aortic balloon pump, levosimendan and dobutamine infusion, α-blockade with phentolamine, surgical removal of the pheochromocytoma, Levitronix® (Levitronix LLC, Waltham, MA) left ventricular assist device implantation.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$209.00 per year
only $17.42 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
References
Sloand, E. M. & Thomson, B. T. Propanolol-induced pulmonary edema and shock in a patient with pheochromocytoma. Arch. Intern. Med. 144, 173–174 (1984).
Westaby, S. et al. Elective transfer from cardiopulmonary bypass to centrifugal blood pump support in very high-risk cardiac surgery. J. Thorac. Cardiovasc. Surg. 133, 577–578 (2007).
Lenders, J. W., Eisenhofer, G., Mannelli, M. & Pacak, K. Phaeochromocytoma. Lancet 366, 665–675 (2005).
Olson, S. W., Deal, L. E. & Piesman, M. Epinephrine-secreting pheochromocytoma presenting with cardiogenic shock and profound hypocalcemia. Ann. Intern. Med. 140, 849–851 (2004).
Cheng, T. O. & Bashour, T. T. Striking electrocardiographic changes associated with pheochromocytoma. Masquerading as ischemic heart disease. Chest 70, 397–399 (1976).
Van Vliet, P. D., Burchell, H. B. & Titus, J. L. Focal myocarditis associated with pheochromocytoma. N. Engl. J. Med. 274, 1102–1108 (1966).
Rona, G. Catecholamine cardiotoxicity. J. Mol. Cell. Cardiol. 17, 291–306 (1985).
Sardesai, S. H., Mourant, A. J., Sivathandon, Y., Farrow, R. & Gibbons, D. O. Phaeochromocytoma and catecholamine induced cardiomyopathy presenting as heart failure. Br. Heart J. 63, 234–237 (1990).
Rosenbaum, J. S. et al. Cardiomyopathy in a rat model of pheochromocytoma. Morphological and functional alterations. Am. J. Cardiovasc. Pathol. 1, 389–399 (1988).
Meerson, F. Z. Pathogenesis and prophylaxis of cardiac lesions in stress. Adv. Myocardiol. 4, 3–21 (1983).
Cebelin, M. S. & Hirsch, C. S. Human stress cardiomyopathy. Myocardial lesions in victims of homicidal assaults without internal injuries. Hum. Pathol. 11, 123–132 (1980).
Pavin, D., Le Breton, H. & Daubert, C. Human stress cardiomyopathy mimicking acute myocardial syndrome. Heart 78, 509–511 (1997).
Lyon, A. L., Rees, P. S., Prasad, S., Poole-Wilson, P. A. & Harding, S. E. Stress (Takotsubo) cardiomyopathy—a novel pathophysiological hypothesis to explain catecholamine-induced acute myocardial stunning. Nat. Clin. Pract. Cardiovasc. Med. 5, 22–29 (2008).
Wood, R., Commerford, P. J., Rose, A. G. & Tooke, A. Reversible catecholamine-induced cardiomyopathy. Am. Heart J. 121, 610–613 (1991).
Takagi, S. et al. Dexamethasone-induced cardiogenic shock rescued by percutaneous cardiopulmonary support (PCPS) in a patient with pheochromocytoma. Jpn Circ. J. 64, 785–788 (2000).
Ogletree-Hughes, M. L. et al. Mechanical unloading restores beta-adrenergic responsiveness and reverses receptor downregulation in the failing human heart. Circulation 104, 881–886 (2001).
Grasselli, G. et al. Extracorporeal cardiopulmonary support for cardiogenic shock caused by pheochromocytoma: a case report and literature review. Anesthesiology 108, 959–962 (2008).
Grinda, J. M. et al. Unusual cardiogenic shock due to pheochromocytoma: recovery after bridge-to-bridge (extracorporeal life support and DeBakey ventricular assist device) and right surrenalectomy. J. Thorac. Cardiovasc. Surg. 131, 913–914 (2006).
Acknowledgements
Written consent for publication was obtained from the patient.
Charles P. Vega, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the MedscapeCME-accredited continuing medical education activity associated with this article.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no competing financial interests.
Rights and permissions
About this article
Cite this article
Westaby, S., Shahir, A., Sadler, G. et al. Mechanical bridge to recovery in pheochromocytoma myocarditis. Nat Rev Cardiol 6, 482–487 (2009). https://doi.org/10.1038/nrcardio.2009.58
Issue Date:
DOI: https://doi.org/10.1038/nrcardio.2009.58
This article is cited by
-
Extracorporeal membrane oxygenation for pheochromocytoma-induced cardiogenic shock
Annals of Intensive Care (2016)