Pheochromocytoma-Induced Atrial Tachycardia Leading to Cardiogenic Shock and Cardiac Arrest: Resolution with Atrioventricular Node Ablation and Pacemaker Placement

Abstract

Pheochromocytoma should be considered in young patients who have acute cardiac decompensation, even Case ReportIn January 2011, a 38-year-old black woman presented at another hospital with cardiogenic shock (left ventricular ejection fraction [LVEF], <0.15) that did not respond to the placement of an intra-aortic balloon pump. She was transferred by helicopter to our cardiac center for further care. The patient then experienced 2 cardiac arrests and needed cardiopulmonary resuscitation for 5 minutes. A TandemHeart ® Percutaneous Ventricular Assist Device (CardiacAssist, Inc.; Pittsburgh, Pa) was inserted emergently. A 12-lead electrocardiogram confirmed atrial tachycardia (Fig. 1A). A trial of intravenous metoprolol caused a complete cessation of blood flow from the TandemHeart device. The patient responded to glucagon and intravenous fluids. Comprehensive electrophysiologic studies revealed multifocal atrial tachycardia and junctional ectopic tachycardia, which were treated with radiofrequency ablation of the atrioventricular (AV) node and the placement of a temporary pacemaker. This treatment dramatically stabilized the patient's hemodynamic status and within a few hours improved her LVEF to 0.25-0.30. Consequently, the patient was weaned off vasopressors, and the TandemHeart was removed. The patient subsequently developed a junctional escape rhythm at 78 beats/min and AV dissociation (Fig. 1B). Her blood pressure was maintained in the normal range after tapering of the vasopressors.

Comparison of Single Culture and the Consortium of Growth-Promoting Rhizobacteria from Three Tomato (Lycopersicon esculentum Mill) Varieties

“…They are due to the secretion of norepinephrine by pheochromocytoma. When betaadrenoceptors are stimulated by excess catecholamine, they can lead to sinus tachycardia, atrial tachyarrhythmia as in our case [5] or even ventricular tachycardias [12], and in rare cases sinus dysfunction [13]. Atrioventricular dissociation was associated with pheochromocytoma in only 2 cases [11].…”

“…In the literature a high incidence of these expressions is reported (19.3%) [4]. The cause of cardiac disorders in patients with pheochromocytoma is chronic tachycardiomyopathy and coronary vasospasm [5]. The diagnostic challenge is the difficulty of linking cardiac manifestations to these adrenergic tumors.…”

Recurrent Stress Cardiomyopathy: A Rare Variant in a Young Patient with Undiagnosed Pheochromocytoma

“…Furthermore, young patients without prior history who suffer from acute cardiac decompensation intraoperatively must be considered for entities such as pheochromocytoma. It has been suggested that supraventricular tachycardia in the presence of pheochromocytoma has led to acute depression in ventricular function, despite cardioversion of the arrhythmia [ 5 ].…”

“…In the absence of LVOT obstruction, supportive care with inotropic use is indicated. Patients may require mechanical support in the form of an intraaortic balloon pump or percutaneous left ventricular assist devices until ventricular function recovers [ 5 ]. Kumar et al report that a perioperative catecholamine surge may be attenuated with pretreatment with IV benzodiazepine, although this has not been extensively studied [ 3 ].…”

Thyrotoxic and pheochromocytoma multisystem crisis: a case report

“…Heart failure and tachycardia with atrial fibrillation, which are the typical complications of thyrotoxic crisis, affect circulation kinetics [ 6 ]. Pheochromocytoma multisystem crisis also causes numerous cardiovascular abnormalities, including life-threatening ventricular arrhythmias, conduction disturbances, cardiogenic shock, and hypertensive emergency [ 7 ].…”