PMID- 38130863
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20240308
IS  - 2514-2119 (Electronic)
IS  - 2514-2119 (Linking)
VI  - 7
IP  - 12
DP  - 2023 Dec
TI  - Paraganglioma-induced reverse takotsubo syndrome treated with extracorporeal 
      membrane oxygenation in a young patient with a history of malignancy: a case 
      report.
PG  - ytad591
LID - 10.1093/ehjcr/ytad591 [doi]
LID - ytad591
AB  - BACKGROUND: Reverse takotsubo-like cardiomyopathy (rTCC) is a rare type of 
      stress-induced cardiomyopathy associated with catecholamine surges. Reverse 
      takotsubo-like cardiomyopathy is characterized by basal and mid-ventricular 
      hypokinesis with apical sparing. Paragangliomas are catecholamine-secreting 
      neuroendocrine tumours outside the adrenal gland that can cause palpitations, 
      hypertension, and rarely cardiomyopathy. In cases of occult paraganglioma, 
      catecholamine-induced rTCC can be rapidly reversed with adequate haemodynamic 
      support. CASE SUMMARY: A 28-year-old woman with a history of cervical cancer, 
      ovarian insufficiency, and preeclampsia presented to the emergency department 
      with nausea, vomiting, and chest pain. The patient was initially tachycardic, 
      tachypnoeic, and hypotensive. On exam, she was in distress with diffuse rales and 
      cool extremities. Electrocardiogram showed sinus tachycardia to 147 b.p.m. and 
      lateral ST depression in V4 and V5. Troponin was elevated to 13 563 ng/L. An 
      echocardiogram showed severely reduced left ventricular ejection fraction (LVEF) 
      with hypokinesis of the basal segments and apical sparing, identified as rTCC. 
      Computed tomography of the abdomen showed a 3.6 x 2.7 cm right adrenal mass. The 
      patient rapidly developed respiratory failure and was subsequently intubated, 
      sedated, and initiated on vasopressors. In the setting of cardiogenic shock 
      refractory to vasopressor support, the decision was made to cannulate for 
      venoarterial extracorporeal membrane oxygenation (VA-ECMO). Plasma and urine 
      metanephrines were elevated. After 5 days, the patient's LVEF recovered to her 
      baseline, and the rTCC had resolved. The patient's hypertension was managed with 
      gradual alpha-blockade, and she subsequently underwent successful adrenalectomy 
      on Day 44. DISCUSSION: An occult paraganglioma should be considered when rTCC 
      pattern is identified. The pathophysiology of paraganglioma-mediated 
      catecholamine surges predisposing to rTCC is unclear. Potential mechanisms for 
      rTCC include oestrogen deficiency, catecholamine cardiotoxicity, and coronary 
      artery spasm. The VA-ECMO is an increasingly used modality to provide 
      haemodynamic support to patients with refractory cardiogenic shock.
CI  - (c) The Author(s) 2023. Published by Oxford University Press on behalf of the 
      European Society of Cardiology.
FAU - Ajluni, Steven C Jr
AU  - Ajluni SC Jr
AUID- ORCID: 0000-0002-7327-4569
AD  - Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, 
      OH, USA.
FAU - Feroze, Rafey
AU  - Feroze R
AD  - Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical 
      Center, Cleveland, OH, USA.
FAU - Asa, Sylvia L
AU  - Asa SL
AD  - Department of Pathology, Case Western Reserve University School of Medicine, 
      Cleveland, OH, USA.
FAU - Sundaram, Varun
AU  - Sundaram V
AD  - Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical 
      Center, Cleveland, OH, USA.
LA  - eng
PT  - Case Reports
DEP - 20231124
PL  - England
TA  - Eur Heart J Case Rep
JT  - European heart journal. Case reports
JID - 101730741
PMC - PMC10733169
OTO - NOTNLM
OT  - Cardiogenic shock
OT  - Case report
OT  - Extracorporeal membrane oxygenation
OT  - Paraganglioma
OT  - Reverse takotsubo cardiomyopathy
OT  - VA-ECMO
COIS- Conflict of interest: None declared.
EDAT- 2023/12/22 06:43
MHDA- 2023/12/22 06:44
PMCR- 2023/11/24
CRDT- 2023/12/22 04:03
PHST- 2023/05/09 00:00 [received]
PHST- 2023/11/16 00:00 [revised]
PHST- 2023/11/22 00:00 [accepted]
PHST- 2023/12/22 06:44 [medline]
PHST- 2023/12/22 06:43 [pubmed]
PHST- 2023/12/22 04:03 [entrez]
PHST- 2023/11/24 00:00 [pmc-release]
AID - ytad591 [pii]
AID - 10.1093/ehjcr/ytad591 [doi]
PST - epublish
SO  - Eur Heart J Case Rep. 2023 Nov 24;7(12):ytad591. doi: 10.1093/ehjcr/ytad591. 
      eCollection 2023 Dec.