Tako-tsubo-like cardiomyopathy and extra-adrenal pheochromocytoma: case report and literature review

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Clin Res Cardiol 97:397–401 (2008) DOI 10.1007/s00392-007-0638-1

Fabio de Souza Ronaldo Altenburg Odebrecht Curi Gismondi Silvio Henriques Cunha Neto Marco Antonio de Mattos


Tako-tsubo-like cardiomyopathy and extra-adrenal pheochromocytoma: case report and literature review

Sirs: Transient left ventricular apical ballooning, also known as Tako-tsubo cardiomyopathy, has been described as being related to cases of acute coronary syndrome with normal coronary arteries [2, 5, 20, 21]. Several cases have been reported in the literature and some case series and studies have been published, proposing various etiologies for this dysfunction [2, 3, 5, 21]. The presence of positive markers for myocardial necrosis and the frequent temporal association with emotional stress point to an adrenergic trigger, which possibly, in combination with other factors that remain to be clarified, would lead to its development [21]. The best known and more often studied pathological condition where there is an adrenergic overload, due to excess of circulating catecholamines, is pheochromocytoma [11]. Other cases have been described connecting pheochromocytoma and Takotsubo-like phenomenon but reports on extra-adrenal variant are extremely uncommon [4, 17]. We herein describe the case of a female patient with a previous history of systemic arterial hypertension Received: 25 August 2007 Accepted: 14 December 2007 Published online: 14 January 2008 F. de Souza, MD (&) R. Altenburg Odebrecht Curi Gismondi, MD M.A. de Mattos, MD, PhD Coronary Care Unit National Institute of Cardiology Rua Cinco de Julho, 63-504, Bairro Copacabana Rio de Janeiro (RJ) 22051-030, Brazil Tel.: +55-21/25497679 or +55-21/96850006 E-Mail: [email protected]

CRC 638

S. Henriques Cunha Neto, MD Dept. of Surgery Federal University of Rio de Janeiro (UFRJ) Rio de Janeiro, Brazil

and clinical presentation mimicking acute coronary syndrome, with transient apical left ventricular dysfunction, in whom a large and unusual extra-adrenal tumor was disclosed. A 31-year-old female patient was seen at the Emergency Department (ED) of a city public hospital with precordial pain associated to palpitations and hypertensive crisis. She was sedentary and had a history of systemic arterial hypertension (diagnosed 6 years earlier during pregnancy) and had been, since then, submitted to regular treatment with angiotensinconverting enzyme inhibitor (ACEI), beta-blocker and thiazide diuretics, albeit without adequate clinical control. At hospital admission, she presented dyspnea, regular crackling sounds at both pulmonary bases, tachycardia (110 beats per minute) with protodiastolic galloping rhythm and blood pressure (BP) 160 · 120 mmHg (Killip-Kimball 2). The electrocardiogram showed ST segment elevation from V2 to V6 with T-wave inversion (Fig. 1). Serum markers were elevated: creatine-kinase (CK) MB fraction: 37, total CK: 380 and troponin I: 9.7 (normal range:
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