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Reversible cardiogenic shock due to catecholamine-induced cardiomyopathy: a variant of takotsubo?

Catherine Law1, Asma Khaliq, Maya Guglin

  • 1Department of Cardiology, University of South Florida, Tampa, FL, USA.

The American Journal of Emergency Medicine
|July 2, 2013
PubMed

Insights

High catecholamine levels can cause reversible left ventricular dysfunction, mimicking takotsubo cardiomyopathy. Consider screening for pheochromocytoma and non-catecholamine vasopressors in these cases.

Area of Science:

  • Cardiology
  • Endocrinology

Background:

  • Catecholamine-induced cardiomyopathy, encompassing takotsubo, neurogenic stunned myocardium, and pheochromocytoma-related cardiomyopathy, is typically reversible.
  • Severe left ventricular systolic dysfunction can manifest as cardiogenic shock and pulmonary edema.

Purpose of the Study:

  • To report a case series of young women with severe left ventricular dysfunction due to high catecholamine levels.
  • To suggest screening for pheochromocytoma in patients with unexplained takotsubo cardiomyopathy.
  • To highlight the potential for intravenous catecholamines to induce transient left ventricular dysfunction.

Main Methods:

  • Case series analysis of young women presenting with cardiogenic shock and pulmonary edema.
  • Measurement of catecholamine levels.
  • Clinical follow-up to assess recovery of left ventricular function.

Main Results:

  • Two young women experienced complete recovery of severe left ventricular systolic dysfunction within 2-3 weeks.
  • Elevated catecholamine levels were identified, linked to pheochromocytoma in one case and high-dose intravenous catecholamines in the other.
  • The condition mimicked takotsubo cardiomyopathy.

Conclusions:

  • Screening for pheochromocytoma is recommended for patients with takotsubo cardiomyopathy of unknown etiology.
  • Intravenous catecholamines can cause significant transient left ventricular dysfunction.
  • Non-catecholamine vasopressors should be considered as alternatives to mitigate this risk.

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