Catecholamine-induced cardiomyopathy - a clinical case

Abstract

A 27-year-old patient presented with a 3-month history of episodic headaches and persistently rising blood pressure (up to 240/120). The clinical, laboratory, and instrumental findings (episodes of severe hypertension, increased levels of metanephrine in urine, and MRI showing a mass of 5.1×5.5 cm in diameter) led us to the diagnosis of pheochromocytoma of the right adrenal grand. Preoperative medication included alpha blockers, calcium channel blockers, and plasma. The right adrenal gland was completely removed using the retroperitoneal access. During the extraction of the tumour, a ventricular tachycardia was recorded after which acute heart failure issued. In the first few hours, echocardiographic imaging showed a reduced EF of 9% – catecholamine-induced cardiomyopathy. The patient underwent a complex and adequate reanimation in the intensive care unit which lasted 20 days. A slow but steady increase in the ejection fraction along with a decrease in congestion was observed. Magnetic resonance imaging was used to confirm the normalisation of myocardial morphology. A German histological laboratory was used to confirm the benign form of the tumour. For the next three months, the patient was on a standard therapy with beta blockers, angiotensin-converting-enzyme inhibitor and mineralocorticoid antagonists. Тhe catecholamine surge during the removal of a large pheochromocytoma could lead to severe cardio-vascular complication, even with a complete and adequate preoperative protective medication. The reversibility of the process implies the necessity of an adequate and timely postoperative treatment for a complete involution of the pathomorphological changes.

Successful robot-assisted laparoscopic resection of pheochromocytoma in a patient with dilated cardiomyopathy: A case report on extremely high-risk anesthesia management

“…[ 18 ] The catecholamine-induced vasoconstriction of small arterioles, a direct toxic effect of catecholamine and its metabolites, and direct receptor-mediated mechanisms are thought to contribute to cardiomyopathy in patients with pheochromocytoma. [ 17 , 19 ] Pheochromocytoma may lead to myocardial fibrosis with both systolic and diastolic dysfunction. [ 20 ] The impaired myocardial function can be improved by active medical treatment or surgery [ 21 ] but may not be completely restored in some patients.…”