Case Reports
Reversible catecholamine-induced cardiomyopathy in a heart transplant candidate without persistent or paroxysmal hypertension

https://doi.org/10.1016/S1053-2498(98)00014-XGet rights and content

Abstract

Background: Both dilated and hypertrophic cardiomyopathy have been reported in patients with pheochromocytoma, who were almost always hypertensive. The outcome frequently has been fatal, yet cardiac dysfunction can be reversible after medical or surgical therapy for the pheochromocytoma.

Methods

We report the case of a patient with dilated cardiomyopathy without persistent or paroxysmal hypertension, who was found to have a pheochromocytoma during initial medical evaluation.

Results

The identification and treatment of the pheochromocytoma led to significant improvement in cardiac function and cardiac transplantation was avoided.

Conclusions

This case illustrates some unusual features in pheochromocytoma-induced cardiomyopathy: (1) absence of persistent or paroxysmal hypertension, (2) initial presentation with acute myocardial infarction and normal coronary arteries, and (3) recurrent episodes of nonsustained ventricular tachycardia.

Section snippets

Case report

A 43-year-old Caucasian woman, with no history of cardiac disease or hypertension, presented with a 3-hour history of severe substernal chest pain, dyspnea, diaphoresis, nausea, and vomiting. Her blood pressure was 180/110 mmHg and pulse was 120 beats/minute. Cardiac and lung examinations were unremarkable. Electrocardiography showed a 1 to 2-mm ST segment elevation in leads I and aVL (Figure 2). Cardiac monitoring demonstrated frequent premature ventricular beats and recurrent episodes of

Reversible catecholamine-induced cardiomyopathy

When a patient presents with severe unexplained systolic heart failure and is evaluated for heart transplantation, causes of reversible cardiomyopathy must be excluded. Thyrotoxicosis, renal failure, septic shock, iron overload, sarcoidosis, hypophosphatemia, hypocalcemia, alcoholism, pheochromocytoma and medications (eg, cocaine) have all been reported to cause reversible cardiomyopathy.2

Catecholamine-induced cardiomyopathy is a recognized complication of pheochromocytoma and may be the only

Conclusion

A 43-year-old patient with pheochromocytoma presented with acute myocardial infarction and normal coronary arteries, developed cardiogenic shock, and had recurrent episodes of nonsustained ventricular tachycardia, without developing persistent or paroxysmal hypertension. She had reversible catecholamine-induced cardiomyopathy, that was discovered during evaluation for cardiac transplantation. Routine screening of heart transplantation candidates for occult catecholamine-secreting tumors, even

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