Skip to main content
Clinical Cardiology logoLink to Clinical Cardiology
. 2010 Apr 8;33(4):200–205. doi: 10.1002/clc.20680

Inverted‐Takotsubo Pattern Cardiomyopathy Secondary to Pheochromocytoma: A Clinical Case and Literature Review

Stephen Kim 1, Anthony Yu 1, Lea A Filippone 2, Daniel M Kolansky 3, Amresh Raina 3,
PMCID: PMC6653389  PMID: 20394039

Abstract

Takotsubo cardiomyopathy is an increasingly recognized clinical syndrome of transient left ventricular dysfunction, commonly with apical ballooning, in the context of physical or emotional stress. Recently, an inverted‐Takotsubo contractile pattern has been described with hypokinesis of the basal and mid‐ventricular segments and sparing of the apex. We report a case of a 30‐year‐old man presenting with transient left ventricular dysfunction in an inverted‐Takotsubo contractile pattern, associated with a newly discovered pheochromocytoma, and present a literature review of the inverted‐Takotsubo contractile pattern cardiomyopathy. Copyright © 2010 Wiley Periodicals, Inc.

Full Text

The Full Text of this article is available as a PDF (1.3 MB).

References

  • 1. Stein PP, Black HR. A simplified diagnostic approach to pheochromocytoma. A review of the literature and report of one institution's experience. Medicine (Baltimore) 1991; 70(1): 46–66. Review. [DOI] [PubMed] [Google Scholar]
  • 2. Wiswell JG, Crago RM. Reversible cardiomyopathy with pheochromocytoma. Trans Am Clin Climatol Assoc 1969; 80: 185–195. [PMC free article] [PubMed] [Google Scholar]
  • 3. Wood R, Commerford PJ, Rose AG, et al. Reversible catecholamine‐induced cardiomyopathy. Am Heart J 1991; 121(2 Pt 1) 610–613. [DOI] [PubMed] [Google Scholar]
  • 4. Schuiki ER, Jenni R, Amann FW, et al. A reversible form of apical left ventricular hypertrophy associated with pheochromocytoma. J Am Soc Echocardiogr 1993; 6(3 Pt 1): 327–331. [DOI] [PubMed] [Google Scholar]
  • 5. Takizawa M, Kobayakawa N, Uozumi H, et al. A case of transient left ventricular ballooning with pheochromocytoma, supporting pathogenetic role of catecholamines in stress‐induced cardiomyopathy or takotsubo cardiomyopathy. Int J Cardiol 2007; 114(1): e15–e17. [DOI] [PubMed] [Google Scholar]
  • 6. Lassnig E, Weber T, Auer J, et al. Pheochromocytoma crisis presenting with shock and tako‐tsubo‐like cardiomyopathy. Int J Cardiol 2009; 134(3): E138–E140. [DOI] [PubMed] [Google Scholar]
  • 7. Von Bergen NH, Lyon JK, Edens, RE. Takotsubo‐like cardiomopathy in a 17‐year‐old male with a pheochromocytoma. Pediatr Cardiol 2009; 30(2): 184–187. [DOI] [PubMed] [Google Scholar]
  • 8. Sato H, Tateishi H, Uchida T. Takotsubo‐type cardiomyopathy due to multivessel spasm In: Kodama K, Haze K, Hon M, eds. Clinical Aspect of Mycardial Injury: From Ischemia to Heart Failure. Tokyo, Japan: Kagakuhyouronsha; 1990; 56–64. [Google Scholar]
  • 9. Hurst RT, Askew JW, Reuss CS, et al. Transient midventricular ballooning syndrome: a new variant. J Am Coll Cardiol 2006; 48(3): 579–583. [DOI] [PubMed] [Google Scholar]
  • 10. Bonnemeier H, Schafer U, Schunkert H. Apical ballooning without apical ballooning. Eur Heart J 2006; 27(18): 2246. [DOI] [PubMed] [Google Scholar]
  • 11. Ravipati G, Aronow WS, Lai H, et al. Comparison of sensitivity, specificity, positive predictive value, and negative predictive value of stress testing versus 64‐multislice coronary computed tomography angiography in predicting obstructive coronary artery disease diagnosed by coronary angiography. Am J Cardiol 2008; 101(6): 774–775. [DOI] [PubMed] [Google Scholar]
  • 12. Leschka S, Scheffel H, Desbiolles L, et al. Combining dual‐source computed tomography coronary angiography and calcium scoring: added value for the assessment of coronary artery disease. Heart 2008; 94(9): 1154–1161. [DOI] [PubMed] [Google Scholar]
  • 13. Cademartiri F, Maffei E, Palumbo A, et al. Diagnostic accuracy of computed tomography coronary angiography in patients with a zero calcium score. Eur Radiol 2010; 20: 81–87. [DOI] [PubMed] [Google Scholar]
  • 14. Shaw TRD, Bafferty P, Tait GW. Transient shock and myocardial impairment caused by pheochromocytoma crisis. Br Heart J 1987; 57(2): 194–198. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 15. Gianni M, Dentali F, Grandi AM, et al. Apical ballooning syndrome or takotsubo cardiomyopathy: a systemic review. Eur Heart J 2006; 27(13): 1523–1529. [DOI] [PubMed] [Google Scholar]
  • 16. Bybee KA, Kara T, Prasad A, et al. Systematic review: transient left ventricular apical ballooning: a syndrome that mimics ST‐segment elevation myocardial infarction. Ann Intern Med 2004; 141(11): 858–865. Review. [DOI] [PubMed] [Google Scholar]
  • 17. Kurowski V, Kaiser A, von Hof K, et al. Apical and midventricular transient left ventricular dysfunction syndrome (tako‐tsubo cardiomyopathy): frequency, mechanisms, and prognosis. Chest 2007; 132(3): 809–816. [DOI] [PubMed] [Google Scholar]
  • 18. Prasad A, Lerman A, Rihal CS. Apical ballooning syndrome (tako‐tsubo or stress cardiomyopathy): a mimic of acute myocardial infarction. Am Heart J 2008; 155(3): 408–417. [DOI] [PubMed] [Google Scholar]
  • 19. Di Valentino M, Balestra GM, Christ M, et al. Inverted takotsubo cardiomyopathy due to pheochromocytoma. Eur Heart J 2008; 29(6): 830. [DOI] [PubMed] [Google Scholar]
  • 20. Jindal V, Baker ML, Aryangat A, et al. Pheochromocytoma: presenting with regular cyclic blood pressure and inverted takotsubo cardiomyopathy. J Clin Hypertens 2009; 11(2): 81–86. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 21. Sanchez‐Recalde A, Costero O, Oliver JM, et al. Images in cardiovascular medicine. Pheochromocytoma‐related cardiomyopathy: inverted Takotsubo contractile pattern. Circulation 2006; 113(17): e738–e739. [DOI] [PubMed] [Google Scholar]
  • 22. Kim HS, Chang WI, Kim YC, et al. Catecholamine cardiomyopathy associated with paraganglioma rescued by percutaneous cardiopulmonary support: inverted Takotsubo contractile pattern. Circ J 2007; 71(12): 1993–1995. [DOI] [PubMed] [Google Scholar]
  • 23. Zegdi R, Parisot C, Sleilaty G, et al. Pheochromocytoma‐induced inverted Takotsubo cardiomyopathy: a case of patient resuscitation with extracorporeal life support. J Thorac Cardiovasc Surg 2008; 135(2): 434–435. [DOI] [PubMed] [Google Scholar]
  • 24. Kimura S, Mitsuma W, Ito M, et al. Inverted Takotsubo contractile pattern caused by pheochromocytoma with tall upright T‐waves, but not typical deep T‐wave inversion. Int J Cardiol 2009; 139: e15–e17. [DOI] [PubMed] [Google Scholar]
  • 25. Cho DK, Kim JH, Chung N. Transient mid‐ventricular ballooning cardiomyopathy associated with bladder pheochromocytoma. Eur Heart J 2009; 30(10): 1202. [DOI] [PubMed] [Google Scholar]
  • 26. Ibanez B, Benezet‐Mazuecos J, Navarro F, et al. Takotsubo syndrome: a Bayesian approach to interpreting its pathogenesis. Mayo Clin Proc 2006; 81(6): 732–735. [DOI] [PubMed] [Google Scholar]
  • 27. Angelakos ET. Regional distribution of catecholamines in the dog heart. Circ Res 1965; 16: 39–44. [DOI] [PubMed] [Google Scholar]
  • 28. Pierpont GL, DeMaster EG, Cohn JN. Regional differences in adrenergic function within the left ventricle. Am J Physiol 1984; 246(6 Pt 2): H824–H829. [DOI] [PubMed] [Google Scholar]
  • 29. Lathers CM, Levin RM, Spivey WH. Regional distribution of myocardial β‐adrenoceptors in the cat. Eur J Pharmacol 1986; 130(1–2): 111–117. [DOI] [PubMed] [Google Scholar]
  • 30. Mori H, Ishikawa S, Kojima S, et al. Increased responsiveness of left ventricular apical myocardium to adrenergic stimuli. Cardiovasc Res 1993; 27(2): 192–198. [DOI] [PubMed] [Google Scholar]

Articles from Clinical Cardiology are provided here courtesy of Wiley

RESOURCES