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Pheochromocytoma as a Rare Hidden Cause of Inverted Stress Cardiomyopathy

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Stress cardiomyopathy (SCMP) is characterized by a transient left ventricular dysfunction associated with apical ballooning andcompensatory hyperkinesias of the basal segments after emotional or physical stress, but inverted or mid-ventricular variants ofSCMP have also been described. Although catecholamine excess has been suggested as a possible pathophysiologic mechanism ofSCMP, the etiology of SCMP is still unknown. Here, we report a case of inverted type of SCMP with clinical presentationmimicking acute coronary syndromes. The cause or precipitating stressor was unclear initially, but pheochromocytoma has beendemonstrated as a cause of SCMP during clinical follow-up at out-patient clinic in the present case. Catecholamine-producingtumors should be included in the evaluation or management of SCMP, even though initial clinical manifestations are notsuggestive for pheochromocytoma.

Abstract

Stress cardiomyopathy (SCMP) is characterized by a transient left ventricular dysfunction associated with apical ballooning andcompensatory hyperkinesias of the basal segments after emotional or physical stress, but inverted or mid-ventricular variants ofSCMP have also been described. Although catecholamine excess has been suggested as a possible pathophysiologic mechanism ofSCMP, the etiology of SCMP is still unknown. Here, we report a case of inverted type of SCMP with clinical presentationmimicking acute coronary syndromes. The cause or precipitating stressor was unclear initially, but pheochromocytoma has beendemonstrated as a cause of SCMP during clinical follow-up at out-patient clinic in the present case. Catecholamine-producingtumors should be included in the evaluation or management of SCMP, even though initial clinical manifestations are notsuggestive for pheochromocytoma.

참고문헌 (12)

  1. Tsuchihashi K, "Angina Pectoris-Myocardial Infarction Investigations in Japan. Transient left ventricular apical ballooning without coronary artery stenosis: a novel heart syndrome mimicking acute myocardial infarction. Angina Pectoris-Myocardial Infarction Investigations in Japan", J Am Coll Cardiol, 38, pp.11~18 (2001)
  2. Bybee KA, "Stress-related cardiomyopathy syndromes", Circulation, 118, pp.397~409 (2008)
  3. 황승환, "Stress Cardiomyopathy Complicated by Left Ventricular Thrombi and Cerebral Infarctions in a Patient with Essential Thrombocythemia", Journal of Cardiovascular Ultrasound, 19(2), pp.87~90 (2011), 한국심초음파학회
  4. Abraham J, "Stress cardiomyopathy after intravenous administration of catecholamines and beta-receptor agonists", J Am Coll Cardiol, 53, pp.1320~1325 (2009)
  5. Renard J, "Pheochromocytoma and abdominal paraganglioma", J Visc Surg, 148, pp.e409~e416 (2011)
  6. Kassim TA, "Catecholamine-induced cardiomyopathy", Endocr Pract, 14, pp.1137~1149 (2008)
  7. Agarwal G, "Cardiovascular dysfunction and catecholamine cardiomyopathy in pheochromocytoma patients and their reversal following surgical cure : results of a prospective case-control study", Surgery, 150, pp.1202~1211 (2011)
  8. Prejbisz A, "Cardiovascular manifestations of phaeochromocytoma", J Hypertens, 29, pp.2049~2060 (2011)
  9. Rossi AP, "Recurrent takotsubo cardiomyopathy associated with pheochromocytoma", Endocr Pract, 15, pp.560~562 (2009)
  10. Kim S, "Inverted-Takotsubo pattern cardiomyopathy secondary to pheochromocytoma : a clinical case and literature review", Clin Cardiol, 33, pp.200~205 (2010)
  11. Cho DK, "Cardiovascular flashlight. Transient mid-ventricular ballooning cardiomyopathy associated with bladder pheochromocytoma", Eur Heart J, 30, pp.1202~ (2009)
  12. Bybee KA, "Systematic review : transient left ventricular apical ballooning : a syndrome that mimics ST-segment elevation myocardial infarction", Ann Intern Med, 141, pp.858~865 (2004)

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