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Reversible catecholamine-induced cardiomyopathy in a heart transplant candidate without persistent or paroxysmal
E S Brilakis1, W F Young, J W Wilson
1Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Insights
Pheochromocytoma can cause dilated cardiomyopathy, even without hypertension. Treating the tumor reversed cardiac dysfunction, avoiding the need for a heart transplant in this unique case.
Area of Science:
- Cardiology
- Endocrinology
Background:
- Pheochromocytoma is associated with cardiomyopathy, typically in hypertensive patients.
- Cardiac dysfunction in these cases is often reversible with tumor treatment.
Observation:
- A patient presented with dilated cardiomyopathy and acute myocardial infarction, notably without sustained hypertension.
- The underlying cause identified during evaluation was a pheochromocytoma.
Findings:
- Treatment of the pheochromocytoma resulted in substantial improvement of cardiac function.
- The patient's cardiac condition improved to the extent that heart transplantation was averted.
Implications:
- This case highlights atypical presentations of pheochromocytoma-induced cardiomyopathy, including lack of hypertension and initial myocardial infarction.
- It underscores the importance of considering pheochromocytoma in unexplained cardiac dysfunction, even in normotensive individuals.
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.