Day 0 |
Epigastric pain after consuming Levosulpiride, followed by haematemesis |
Day 0, 1 h |
Emergency Department: pH 6.8, PaO2/FiO2 150 mmHg requiring endotracheal intubation; electrocardiogram: sinus tachycardia, ST-segment elevation in anterior and lateral leads; transthoracic echocardiography: akinesia of all middle and apical segments of the left ventricle, left ventricular ejection fraction (LVEF) 20% |
Day 0, 2 h |
Thoracic and abdominal computed tomography scan showing a mass (5 cm) of the left adrenal gland (suggestive of a pheochromocytoma) |
Day 0, 3 h |
Coronary angiography: no evidence of relevant coronary artery disease; left ventricular angiography showing apical ballooning with severe reduction in LV function (LVEF 15%) |
Day 0, 4 h |
Cardiac arrest after Labetalol administration: ventricular fibrillation, CPR, DC-shock 6×, pulseless electrical activity; implantation of Impella CP®, high dose of epinephrine intravenous (i.v.) infusion |
Day 1 |
Tapering and end of epinephrine i.v. infusion |
Day 2 |
Introduction of Doxazosine, Metoprolol, and Amlodipine |
Day 3 |
Introduction of i.v. Urapidil due to resistant hypertension |
Day 4 |
Improved LV function (LVEF 45%), removal of Impella CP®
|
Day 33 |
Pheochromocytoma confirmed by significantly increased urinary concentration of metanephrine and normetanephrine |
Day 42 |
Left sided laparoscopic adrenalectomy, uncomplicated |
Day 46 |
Patient’s discharge |