Article

Pheochromocytoma mimicking (or triggering?) takotsubo cardiomyopathy and hypertrophic cardiomyopathy

Correspondence / American Journal of Emergency Medicine 35 (2017) 508515 511

Table 1

CPR quality according to the oxygenation device.

Takotsubo syndrome (TTS) in the setting of pheochromocytoma (PHEO) are: 1) that the title of the paper refers to the transient left

bag-valve mask

CPR duration (s) 963 [948;

1116]

Continuous insufflation of p oxygen

962 [919; 1072] 0.81

ventricular dysfunction noted, as “mimicking” TTS in a patient with PHEO, than “triggered” by it, thus subscribing to the outmoded opin- ion forwarded by the Mayo Clinic criteria (including the revised ones) [2], according to which PHEO is a condition to be excluded

Case management duration (s)

chest compression rate (/min)

1003 [995;

1172]

110

[103-112]

1003 [977; 1138] 0.88

109 [104-116] 0.69

when the diagnosis of TTS is made (this is a view opposed by many other workers in the field [3-7]); and 2) that the authors detected on cardiac magnetic resonance imaging (cMRI) “severe mid- and

chest compression depth (cm)

5.7 [4.8-55.9] 5.3 [4.1-5.6] 0.88

apical-hypertrophy (wall thickness 20 mm)”, and further

commented that “PHEOs are associated with several cardiovascular

CPR fraction (%) 75.7 86.2 [81.7-87.2] b0.001

[72.5-78.8]

Arnaud Gaillard

Haute-Savoie Fire Department, Meythet, France

Cecile Ricard

Department of Emergency Medicine, SAMU 74, Annecy Genevois Hospital,

Annecy, France

Claire Vallenet

Haute-Savoie Fire Department, Meythet, France

Olivier Baptiste

Haute-Savoie Fire Department, Meythet, France

Vincent Peigne

Haute-Savoie Fire Department, Meythet, France Intensive Care Unit Metropole-Savoie Hospital, Chambery, France Corresponding author at: Intensive Care Unit Metropole-Savoie Hospital

Place Lucien Biset, 73000 Chambery, France

E-mail address: [email protected] http://dx.doi.org/10.1016/j.ajem.2016.11.045

References

  1. Yu H, Qing H, Min Y. Continuous passive oxygen insufflation for out-of-hospital cardiac arrest: a systemic review of clinical studies. Resuscitation 2013;84: e9-10.
  2. Steen S, Liao Q, Pierre L, Paskevicius A, Sjoberg T. Continuous intratracheal insufflation of oxygen improves the efficacy of Mechanical chest compression-active decompres- sion CPR. Resuscitation 2004;62:219-27.
  3. Segal N, Voiglio EJ, Rerbal D, Jost D, Dubien P-Y, Lanoe V, et al. Effect of continuous ox- ygen insufflation on induced-gastric air volume during cardiopulmonary resuscita- tion in a cadaveric model. Resuscitation 2015;86:62-6.

Pheochromocytoma mimicking (or triggering?) takotsubo cardiomyopathy and Hypertrophic cardiomyopathy

To the Editor,

The 2 reasons that prompted me to provide this commentary on the interesting report by Gravina et al., published ahead of print on November 1, 2016 in the Journal [1], about a patient who suffered

complications, including left ventricular (LV) hypertrophy” [1]; however the authors’ patient was not found to be hypertensive, and the noted hypertrophy probably represented LV “pseudohypertrophy”, a reversible condition found in TTS, diagnosed by cMRI, and often misdiagnosed in the literature as LV hypertrophy due to hypertophic cardiomyopathy, or LV hypertrophy due to hy- pertension in general, or specifically PHEO-induced hypertension [8-10]; also the authors did not mention whether myocardial edema was detected in their patient by the cMRI; it would be of in- terest to document the regression of the LV apparent “hypertrophy” in their patient, by a repeat cMRI study.

Conflicts of interest

There are no conflicts of interest to disclose.

Acknowledgments

No funding has been received for this work.

John E. Madias Icahn School of Medicine at Mount Sinai, New York, NY, United States Division of Cardiology, Elmhurst Hospital Center, Elmhurst, NY, United States Corresponding author at: Division of Cardiology, Elmhurst Hospital Center, 79-01 Broadway, Elmhurst, 11373, NY, United States

E-mail address: [email protected] http://dx.doi.org/10.1016/j.ajem.2016.12.011

References

  1. Gravina M, Casavecchia G, D’Alonzo N, Totaro A, Manuppelli V, Cuculo A, et al. Pheochromocytoma mimicking takotsubo cardiomyopathy and hypertrophic car- diomyopathy: a cardiac magnetic resonance study. Am J Emerg Med 2017;35: 553-5.
  2. Prasad A, Lerman A, Rihal CS. Apical ballooning syndrome (takotsubo or stress car-

diomyopathy): a mimic of acute myocardial infarction. Am Heart J 2008;155: 408-17.

  1. Madias JE. Why the current diagnostic criteria of takotsubo syndrome are outmod- ed: a proposal for new criteria. Int J Cardiol 2014;174:468-70.
  2. Samuels MA. The brain-heart connection. Circulation 2007;116:77-84.
  3. Champion S. Takotsubo cardiomyopathy related to pheochromocytoma or other eti- ology should be considered as similar. Korean Circ J 2015;45:535.
  4. Santoro F, Ferraretti A, Tarantino N, Di Biase M, Brunetti ND. Takotsubo cardiomyop- athy and pheochromocytoma: “what therefore God hath joined together, let not man put asunder”. Int J Cardiol 2016;203:449.
  5. Santoro F, Ferraretti A, Tarantino N, Di Biase M, Brunetti Pheochromocytoma ND. Still an exclusion criterion for tako-tsubo cardiomyopathy diagnosis? Int J Cardiol 2015;201:32.
  6. Madias JE. Two cases of reversible left ventricular hypertrophy during re- covery from takotsubo cardiomyopathy: hypertrophy or myocardial edema after an attack of takotsubo syndrome? Echocardiography 2013; 30:989.
  7. Madias JE. Apparent myocardial hypertrophy due to reversible regional myocardial edema in takotsubo syndrome. Echocardiography 2015;32:403.
  8. Madias JE. Transient apical pseudohypertophy due to myocardial edema in patients with takotsubo syndrome. Heart Lung 2016;45:81.

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