Acute Myocardial Infarction Secondary to Catecholamine Release Owing to Cocaine Abuse and Pheochromocytoma Crisis

Abstract

Most pheochromocytomas are not suspected clinically while a high percentage of them are curable with surgery. We present the case of an adult cocaine-addicted male patient with an underlying pheochromocytoma and repeated myocardial infarctions. Computed tomography showed a left round adrenal mass, also high 24-hour urine levels of catecholamines and metanephrines were detected from urinalysis. The patient was given alpha and beta blockers, moreover a laparoscopic left adrenalectomy was performed. Cocaine can block the reuptake of noradrenaline, leading to increasing its concentration and consequently its effects as well, and induce local or diffuse coronary vasoconstriction in normal coronary artery segments per se, cocaine can also trigger pheochromocytoma crisis, and therefore, cardiac complications such as myocardial infarction due to these additive effects are intended to occur. For this reason, in the presence of typical clinical manifestations of pheochromocytoma, such as sustained or paroxysmal hypertension, headache, sweating, tachycardia and abdominal pain, probable association of this tumor in patients with cocaine abuse and associated cardiac complications must be ruled out.

The Great Masquerader

“…The aldosterone/PRA ratio has the best diagnostic performance to screen for primary aldosteronism. It's considered as the pivotal test for the etiological diagnosis of hypertension with hypokalemia (3) , and the test of urinary metanephrines and normetanephrines will lead to diagnosis a pheochromocytoma (4) as was the case of our patient. The curative treatment of pheochromocytoma is based on surgical excision of the tumour.…”

Pheochromocytoma and Hypertrophic Cardiomyopathy Leading to Cardiac Arrest

“…It is proposed that there may also be a role in oxidative stress and the production of oxyradicals, which cause cardiotoxic effects [12]. Similar mechanisms of myocardial injury have also been proposed in chronic cocaine use, and both cocaine-induced and pheochromocytoma-induced cardiac injury share a similar histological appearance [13]. Links to nodal dysfunction have also been explored -among hyper-catecholaminergic states, catecholamine-induced tachyarrhythmias that progress to ventricular fibrillation are the primary cause of cardiac arrest.…”

The case of acute myocardial damage of patient with pheochromocytoma

“…Так, описаны случаи отека легких на фоне приема пропранолола у больных с ФХ [32]. Тяжелые симпатоадреналовые кризы может вызывать прием кокаина [17].…”

“…3, г, д). Общая или очаговая дисфункция миокарда в отсутствии очаговых изменений перфузии не характерна для патологии коронарных артерий и ишемической болезни сердца, а является признаком диффузных изменений миокарда при кардиопатиях [17]. На фазовых изображениях миокарда показана диффузная асинхрония (отражает нарушение электромеханического сопряжения), что также является признаком кардиопатии [18] (рис.…”