Akuter Myokardinfarkt bei der Phäochromozytom-Krise

Abstract

A myocardial infarction is a rare complication of a pheochromocytoma. A pheochromo-cytoma crisis may occur spontaneously, during pregnancy, or may be induced by a local trauma of the tumor or by drugs. We present a case report of a 41-year-old woman without anamnestic episodes of hypertension or angina pectoris. During angiography of the mesenteric arteries for further diagnostics of a sonographically suspected liver tumor, she developed an acute pulmonary edema and a cardiogenic shock with the electro- and echocardiographic findings of a large anterolateral-apical-diaphragmal myocardial infarction. The immediate coronary angiography 90 min after the onset of the myocardial infarction showed normal coronary arteries with normal coronary blood flow of the arteries supplying myocardial areas with akinetic segments and those arteries supplying hyperkinetic segments. The blood catecholamine levels at this time were excessively elevated. The left ventricular function improved to almost normal within the next 4 weeks with the beginning of the improvement already before the abdominal tumor was surgically removed at day five. The histology documented a pheochromocytoma with acute necrosis. The early invasive findings support the hypothesis that a reversible spasm of several epicardial arteries and not a direct toxic effect of catecholamines could have been the cause of the small myocardial infarction and the observed large myocardial stunning.

Cardiovascular Manifestations and Complications of Pheochromocytomas and Paragangliomas

“…A pheochromocytoma presenting with chest pain, troponin elevation and normal coronary angiography, and deemed as myocardial infarction with non-obstructive coronary arteries (MINOCA) in a 79-years-old woman has been recently reported [49]; information on cardiac image study was lacking. Several other patients with typical features of TS have been described with the diagnosis of acute myocardial infarction [50][51][52] (Table 1). "Acute anterior myocardial infarction with non-Q reinfarction" in association with a pheochromocytoma has been described in a 30-year-old pregnant woman during the 33rd week of gestation [53].…”

“…Second, many cases with features and course typical for PPGL-induced TS, specially before recognition of the term takotsubo, have been published under various cardiac diagnoses [27] as recurrent myocardial infarction with left ventricular aneurysm complicated by left ventricular thrombus [50], "transient shock and myocardial impairment caused by pheochromocytoma crisis" [54], reversible catecholamine-induced cardiomyopathy [57,104], myocardial stunning-like phenomenon during a PPGL-crisis [105], myocarditis diagnosed by C-MRI [61] and so on (Table 1) [51,52,55,56,[58][59][60]. Batisse-Lignier et al reviewed systematically 145 published cases of pheochromocytoma-induced "acute and chronic cardiomyopathy" [106].…”

Crise de feocromocitoma simulando um infarto agudo do miocárdio em paciente com artérias coronárias normais

“…Pheochromocytoma-induced myocardial disease may take the form of ventricular hypertrophy due to long-standing hypertension 2 , dilated cardiomyopathy because of persistent and prolonged exposure to high levels of catecholamines 3 , or, r arely, it may mimic an acute myocardial infarction [4][5][6][7][8][9] . We report the case of a rare association between pheochromocytoma and reversible myocardial dysfunction in a patient with normal coronaries.…”

“…None of these situations is likely in the present case. Wall motion abnormalities have not been well characterized, but both segmental 6 and global 7 myocardial dysfunction have been reported. Although they are commonly associated, the ischemic ECG changes may not be accompanied by wall motion abnormalities 8 .…”