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

Intern Med. 2015;54(18):2343-9. doi: 10.2169/internalmedicine.54.4732. Epub 2015 Sep 15.

Abstract

A 33-year-old woman experienced near-syncope at a hospital. Electrocardiography revealed an intermittent ventricular rhythm. The echocardiogram at admission indicated mild hypokinesis and severe diffuse hypokinesis with reverse takotsubo cardiomyopathy on the following day. The patient experienced abdominal pain on the admission day, and computed tomography identified a large left adrenal mass. Her catecholamine levels increased remarkably on the third day. The wall motion improved on the twelfth day. The tumor was successfully resected and the patient was diagnosed with an ectopic pheochromocytoma. The ventricular rhythm with myocardial damage and hypotension induced by the reverse takotsubo cardiomyopathy masked the characteristic symptoms of pheochromocytoma.

Publication types

  • Case Reports

MeSH terms

  • Abdominal Pain / etiology
  • Adrenal Gland Neoplasms / complications
  • Adrenal Gland Neoplasms / diagnosis*
  • Adrenal Gland Neoplasms / physiopathology
  • Adrenal Gland Neoplasms / therapy
  • Adrenergic beta-Antagonists / administration & dosage
  • Adult
  • Biomarkers / urine
  • Cardiac Catheterization / methods
  • Cardiotonic Agents / administration & dosage
  • Catecholamines / urine*
  • Electrocardiography
  • Female
  • Heart Rate*
  • Heart Ventricles / physiopathology
  • Humans
  • Hypotension / etiology*
  • Hypotension / physiopathology
  • Milrinone / administration & dosage
  • Myocardium / pathology*
  • Pheochromocytoma / complications
  • Pheochromocytoma / diagnosis*
  • Pheochromocytoma / physiopathology
  • Pheochromocytoma / therapy
  • Syncope / etiology
  • Takotsubo Cardiomyopathy / complications
  • Takotsubo Cardiomyopathy / diagnosis*
  • Takotsubo Cardiomyopathy / pathology
  • Takotsubo Cardiomyopathy / physiopathology
  • Takotsubo Cardiomyopathy / therapy
  • Treatment Outcome

Substances

  • Adrenergic beta-Antagonists
  • Biomarkers
  • Cardiotonic Agents
  • Catecholamines
  • Milrinone