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Analysis of Cardiac Contractile Dysfunction and Ca2+ Transients in Rodent Myocytes
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Catecholamine-induced transient myocardial dysfunction.

Arjun K Ghosh1, Emma Hatfield, Susan Connolly

  • 1Cardiovascular Medicine, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London UK.

BMJ Case Reports
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This case report highlights phaeochromocytoma, a rare adrenal tumor, causing acute myocardial stunning due to a catecholamine surge. Prompt alpha blockade treatment led to significant recovery, demonstrating a crucial link between adrenal tumors and cardiac dysfunction.

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Area of Science:

  • Cardiology
  • Endocrinology
  • Oncology

Background:

  • Phaeochromocytoma is a rare neuroendocrine tumor arising from chromaffin cells, typically in the adrenal medulla.
  • Catecholamine excess from phaeochromocytoma can precipitate various cardiovascular complications, including hypertensive crisis and arrhythmias.
  • Acute myocardial stunning, a transient left ventricular dysfunction, is an under-recognized manifestation of catecholamine surge.

Purpose of the Study:

  • To present a case of acute myocardial stunning secondary to catecholamine surge from a phaeochromocytoma.
  • To illustrate the diagnostic challenges and therapeutic approach in such cases.
  • To emphasize the importance of considering phaeochromocytoma in patients with unexplained cardiac dysfunction and labile hypertension.

Main Methods:

  • Case presentation of a 39-year-old male with chest pain, labile blood pressure, ECG changes, and elevated troponin.
  • Diagnostic workup included echocardiography, renal ultrasonography, coronary angiography, and metaiodobenzylguanidine (MIBG) scanning.
  • Therapeutic interventions involved intravenous alpha blockade, oral adrenergic blockade, and surgical removal of the adrenal mass.

Main Results:

  • Echocardiography revealed severe global left ventricular systolic impairment with basal segment sparing.
  • Ultrasonography identified a 6 cm left adrenal mass, leading to suspicion of phaeochromocytoma.
  • Intravenous alpha blockade resulted in dramatic clinical improvement and near-resolution of echocardiographic abnormalities.
  • Coronary angiography showed normal coronary arteries, excluding ischemic heart disease.
  • MIBG scan confirmed the diagnosis, and laparoscopic removal of the left phaeochromocytoma was successful.

Conclusions:

  • Catecholamine surge from phaeochromocytoma can induce acute myocardial stunning.
  • Early diagnosis and management with alpha-adrenergic blockade are critical for clinical and echocardiographic recovery.
  • Surgical resection of phaeochromocytoma is the definitive treatment, resolving the underlying cause of myocardial dysfunction.