1997 Volume 4 Issue 2 Pages 117-123
A 36 year-old male came in complaining of severe back painand then went into shock. ECG revealed poor anterior R progression without any ST-T changes. The left ventricular wall was hypokinetic on echocardiography. The chest X-ray showed pulmonary edema and the thoraco-abdominal CT revealed a right adrenal tumor. A tentative diagnosis of acute myocarditis was made.
The patient was markedly unstable hemodynamically showing severe hypotension which responded poorly to increased doses of catecholamines. This was followed by normal blood pressure requiring no pressor agents. Intraaortic balloon pumping (IABP) was started when systolic blood pressure remained at 70mmHg. The state of shock persisted and systolic blood pressure fell to 60mmHg. We put the patient on extra-corporeal lung and heart assist (ECLHA). The patient's hemodynamic state stabilized on ECLHA but started to show periodic hypertensive attacks (>200mmHg). Catecholamine concentration was found to be abnormally high.
A diagnosis of pheochromocytoma of the right adrenal gland was made. The tumor was resected surgically without complications, but an ECG two weeks later showed q-waves and negative t-waves. The possibility of micro-myocardial damage cannot be ruled out.
We believe ECLHA may be an effective option to support the cardiovascular system during catecholamine crisis in patients with pheochromocytoma. ECLHA may make it possible to save patient in severe shock and to prevent catecholamine-induced myocardial damage by reducing catecholamine dosage during ECLHA.
