Takotsubo Cardiomyopathy: A Net Outcome
Document Type
Article
Abstract
Background: Catecholamine surge secondary to an emotional or physical stressor has been largely associated with Takotsubo Cardiomyopathy (TTC). Atypical presentations of neuroendocrine tumors (NET) have become more prevalent compared to the classic triad of headache, palpitations, and diaphoresis. Initial presentation with cardiogenic shock and recurrent TTC is very rare, as TTC recurrence rate is very low at roughly 4%.
Case: A 74-year-old female with past medical history of remote Takotsubo Cardiomyopathy, stable non-functional left adrenal mass presented 5 years later with severe back pain, diaphoresis and developed cardiogenic shock. Initial ECHO revealed a new severely reduced left ventricular ejection fraction (LVEF). Coronary angiography revealed non-obstructive CAD. Repeat Echo 10 days later showed normalized LVEF. During that same admission, she developed flash pulmonary edema in the setting of uncontrolled hypertension and was found with recurrent LV dysfunction within 3 days of recovery. Metanephrines were elevated. She was empirically started on doxazosin given known history of left adrenal mass, previously biopsy negative. Repeat Echo 2 months later revealed normalized LVEF.
Decision-making: Given the cyclic development of LV dysfunction in the setting of known adrenal mass, there was a high suspicion for a pheochromocytoma resulting in recurrent TTC. Whole body MIBG Scan revealed focal radiotracer activity at the adrenal mass and the patient underwent surgical resection. Surgical pathology revealed this was a paraganglioma arising from a neighboring nerve. Post adrenalectomy, patient’s blood pressures have been controlled off of antihypertensive medications.
Conclusion: Atypical presentation of nonischemic cardiomyopathy with rapid fluctuations in LVEF warrants early evaluation for NET induced TTC to prevent irreversible cardiomyocyte changes. Stable adrenal mass size does not rule out NET, and further testing including hormonal evaluation and nuclear imaging should be considered in the setting of recurrent NICM and cardiogenic shock.
First Page
2761
DOI
10.1016/S0735-1097(22)03752-4
Publication Date
3-8-2022
Recommended Citation
Racharla L, Shah S, Ali M, Kher A, Sheikh T, Vyas AV, Hodavance S. TAKOTSUBO CARDIOMYOPATHY: A NET OUTCOME. Journal of the American College of Cardiology. 2022 Mar 8;79(9_Supplement):2761-.