SHM Converge Scientific Abstract ePoster Gallery-Not a Broken Heart

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This case highlights the link between pheochromocytoma and Takotsubo cardiomyopathy (TTC). A 32-year-old woman with anxiety, depression, prior heroin use, and hepatitis C presented with tremors, chest pain, and vomiting, plus a history of intermittent flushing and tremors. She had rising troponins, ECG changes, and an echocardiogram showing reduced ejection fraction with apical/lateral hypokinesis, initially interpreted as NSTEMI with TTC. However, coronary angiography showed normal coronary arteries, and chest/abdominal imaging revealed a right adrenal mass. MRI confirmed a 46 mm adrenal lesion, and pathology established pheochromocytoma.<br /><br />The report emphasizes that pheochromocytoma can present without hypertension, especially in epinephrine-secreting tumors, and may mimic acute coronary syndrome or TTC. Catecholamine excess can cause myocardial injury through microvascular dysfunction, ischemia, and direct toxicity. Symptoms may include the classic triad of headache, diaphoresis, and palpitations, but also flushing, nausea, pallor, fever, and weight loss. Serious cardiovascular complications include heart failure, cardiogenic shock, and cardiomyopathy.<br /><br />Diagnostic criteria for TTC require all four of the following: transient left ventricular systolic dysfunction with wall-motion abnormalities extending beyond a single coronary territory; absence of obstructive coronary disease or plaque rupture; new ECG changes or modest troponin elevation; and absence of pheochromocytoma or myocarditis. Because pheochromocytoma can cause a TTC-like presentation, it must be excluded in suspected cases.<br /><br />Diagnosis of pheochromocytoma is made with plasma or 24-hour urinary fractionated metanephrines/catecholamines, followed by CT or MRI localization. Treatment includes alpha-blockade before beta-blockade to avoid hypertensive crisis, then surgical adrenalectomy.

Asset Subtitle

Ayeman Basith

Meta Tag

Author List Ayeman Basith, Daniel Sausen, Manasi Shah, Syed Muqeemuddin

Category Clinical Vignettes

Concept Pheochromocytoma

Concept Catecholamine Secretion

Concept Takotsubo Cardiomyopathy

Concept Alpha Blockade

Concept Adrenalectomy

Distinguished Non-Finalist

Presenter Organization Eastern Virginia Medical School

Presenting Author Ayeman Basith

Track Adult

Keywords

pheochromocytoma

Takotsubo cardiomyopathy

adrenal mass

catecholamine excess

acute coronary syndrome

normal coronary arteries

echocardiogram

troponin elevation

alpha-blockade

adrenalectomy

Pheochromocytoma

Catecholamine Secretion

Takotsubo Cardiomyopathy

Alpha Blockade

Adrenalectomy