Abstract
We experienced a 67-year-old woman with pheochromocytoma representing as takotsubo cardiomyopathy. The patient was admitted to our hospital with nausea and vertigo. Three days after admission she complained of discomfort in her chest and ST elevation was observed. We suspected acute coronary syndrome, and an emergent cardiac catheterization was performed. The coronary angiography revealed no obstructive coronary lesion, however, apical ballooning was observed on the left ventriculography. She was diagnosed as having takotsubo cardiomyopathy and admitted to ICU. We started to control her tachycardia with landiolol, an ultra-short acting β-1 adrenoceptor antagonist. Thereafter, she continued to vomit and we gave her intravenous droperidol. After that, her blood pressure decreased immediately and her heart rate increased. We tried to treat it with fluid resuscitation and phenylephrine, but it was insufficient. As a result, we increased the dosage of landiolol, and it was effective for stabilizing her hemodynamics. We started oral administration of propranolol and decreased intravenous landiolol. Her hemodynamic state became stabilized, and she was able to be discharged from ICU. However she died due to severe metabolic acidosis and disseminated intravascular coagulation following the development of intestinal ischemia. Pathological findings revealed pheochromocytoma on her left adrenal gland. Contraction band necrosis that was found at the endocardium of her left ventricle apex suggested brief vasospastic episodes of occlusion followed by vasodilatation and reperfusion. We speculated that coronary microvascular spasm caused by catecholamine overproduction might have contributed to the abnormality of the left ventricle wall motion, and landiolol might have improved it.
