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Published on: February 16, 2011
Pheochromocytoma-related cardiomyopathy presenting as acute myocardial infarction: A case report
Xuandong Jiang1,2, Weimin Zhang2, Qiang Fang1
1Intensive Care Unit, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou.
Insights
Pheochromocytoma (PHEO) can cause catecholamine-induced cardiomyopathy (CICMP), mimicking acute coronary syndrome. Surgical resection of the adrenal mass and medical management are crucial for recovery.
Area of Science:
- Cardiology
- Endocrinology
- Oncology
Background:
- Pheochromocytoma (PHEO)-related cardiomyopathy (CICMP) is a rare condition caused by excessive catecholamine release.
- CICMP presents with symptoms similar to acute coronary syndrome (ACS), including chest pain, myocardial ischemia, and necrosis.
Observation:
- A 63-year-old woman presented with symptoms of acute non-ST segment elevation myocardial infarction, but coronary angiography revealed normal results.
- The patient subsequently developed heart failure symptoms, arrhythmia, and blood pressure fluctuations, indicative of a more complex cardiac condition.
Findings:
- Diagnosis of PHEO and CICMP was established.
- Treatment involved monitoring cardiac output and administering alpha and beta-adrenergic receptor blockers, followed by laparoscopic resection of the adrenal mass.
Implications:
- PHEO is a critical differential diagnosis for patients presenting with ACS-like symptoms and normal coronary arteries.
- Prompt diagnosis and management, including surgical intervention and medical therapy, are essential for favorable outcomes in CICMP.
- Understanding the similarities between CICMP and takotsubo cardiomyopathy (TTC) is vital for accurate diagnosis and treatment planning.
Introduction:
Pheochromocytoma (PHEO)-related cardiomyopathy is a rare condition in which release of a large amount of catecholamines leads to severe vasoconstriction, coronary vasospasm, myocardial ischemia, injury, and necrosis. Its clinical manifestations can be similar to those of acute coronary syndrome.
Patient Concerns:
A 63-year-old woman was diagnosed with acute non-ST segment elevation myocardial infarction following chest pain for 8 hours. The results of coronary angiography were normal. The patient developed dyspnea, cough with frothy pink sputum, paroxysmal sweating, arrhythmia, and blood pressure fluctuation, and was transferred to the intensive care unit for monitoring and treatment.
Diagnosis:
PHEO, catecholamine cardiomyopathy (CICMP).
Intervention:
After monitoring the pulse index continuous cardiac output and treatment with α and β adrenergic receptor blockers for 18 days, laparoscopic resection of the left adrenal mass was performed.
Outcomes:
The patient's condition improved and she was discharged 31 days after admission. Outpatient follow-up examinations 1 month and 1 year later did not show recurrence.
Lessons:
PHEO can cause CICMP, the manifestations of which are partly similar to those of takotsubo cardiomyopathy (TTC). Once the patient's condition stabilizes, surgery should be considered. Fluid management is necessary, and agents such as α and β adrenergic receptor blockers should be administered.
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