Atypische Tako-Tsubo-Kardiomyopathie bei einer jungen Patientin mit Phäochromozytom

Die Tako-Tsubo-Kardiomyopathie ähnelt in ihrer Symptomatik einem Myokardinfarkt – tritt aber bei gesunden Koronargefäßen auf. Ursache für die Funktionsstörung des Herzmuskels ist meist ein traumatisches Erlebnis, weshalb sie auch die Namen „Stress-Kardiomyopathie“ und „Broken Heart Syndrome“ trägt. In dem hier beschriebenen Fall war die Ursache allerdings an anderer Stelle zu suchen: nämlich an der Nebenniere.

Abstract

History and clinical findings | A 42-year old female patient was admitted in cardiogenic shock with pulmonary edema requiring prehospital intubation and mechanical ventilation.

Investigations | Emergency cardiac catheterization because of suspected acute coronary syndrome excluded coronary artery disease. Ventriculography and echocardiography suggested an inverse Tako-Tsubo cardiomyopathy with akinesia of the basal left ventricular myocardium and only apical preserved wall motion.

Treatment and course | Under intensive care therapy with mechanical ventilation, inotropic support, infusion of saline and intraaortal balloon pumping, left ventricular function improved. After discontinuation of mechanical ventilation and discharge from ICU, the patient repeatedly suffered from panic attacks. She was therefore transferred to a psychosomatic center. There she exhibited repeated hypertensive crisis. Ultrasound of the kidney showed an adrenal mass. Together with elevated plasma catecholamines, the diagnosis of pheochromocytoma was suspected. This could be proved by magnetic resonance imaging. After surgical removement of the adrenal mass, the patient was free of symptoms.

Schlüsselwörter

Tako-Tsubo-Kardiomyopathie - Stressinduzierte Kardiomyopathie - Phäochromozytom - kardiogener Schock

Keywords

Tako-Tsubo cardiomyopathy - stress-induced cardiomyopathy - pheochromocytoma - cardiogenic shock

• Literatur

• 1 Desmet WJ, Adriaenssens BF, Dens JA. Apical ballooning of the left ventricle: first series in white patients. Heart 2003; 89: 1027-1031
• 2 Glöckner D, Dissmann M, Behrens S. Atypical acute myocardial ischemia syndrome with reversible left ventricular (LV) wall motion abnormalities („apical ballooning“) without significant coronary artery disease. Z Kardiol 2004; 93: 156-161
• 3 Madhavan M, Prasad A. Proposed Mayo Clinic criteria for the diagnosis of Tako-Tsubo cardiomyopathy and long-term prognosis. Herz 2010; 35: 240-243
• 4 Naderi N, Amin A, Setayesh A et al. Pheochromocytoma-induced reverse tako-tsubo with rapid recovery of left ventricular function. Cardiol J 2012; 19: 527-531
• 5 Sanchez-Recalde A, Costero O, Oliver JM et al. Pheochromocytoma-related cardiomyopathy: inverted Takotsubo contractile pattern. Circulation 2006; 113: e738-e739
• 6 Pfister R, Diedrichs H, Dietlein M et al. Typical and atypical takotsubo-like cardiomyopathy as a manifestation of pheochromocytoma. J Endocrinol Invest 2008; 31: 382-383
• 7 Sato H, Tateishi H, Uchida T et al. Tako-tsubo-like left ventricular dysfunction due to multivessel coronary spasm. in: Kodama K, Haze K, Hori M, Eds Clinical Aspect of Myocardial Injury: From Ischemia to Heart Failure. Tokyo: Kagakuhyoronsha Publishing Co; 1990: 56-64
• 8 Schneider B, Athanasiadis A, Schwab J et al. Clinical spectrum of tako-tsubo cardiomyopathy in Germany: results of the tako-tsubo registry of the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte (ALKK). Dtsch Med Wochenschr 2010; 135: 1908-1913
• 9 Tsuchihashi K, Ueshima K, Uchida T et al. Angina Pectoris-Myocardial Infarction Investigations in Japan. Transient left ventricular apical ballooning without coronary artery stenosis: a novel heart syndrome mimicking acute myocardial infarction. J Am Coll Cardiol 2001; 38: 11-18
• 10 Zanobetti M, Vicidomini S, Conti A et al. An atypical case of inverted Tako-Tsubo syndrome: case report and review of the literature. Intern Emerg Med 2010; 5: 215-219