The Heart of the Issue: A Case Report of Recurrent Reversible Stress-Induced Cardiomyopathy.

Abstract

Patient: Female, 69-year-oldFinal Diagnosis: PheochromocytomaSymptoms: Anxiety • headache • hearing impairment • hypertensive crisis • paresthesia • pulmonary edema • slurred speechMedication:—Clinical Procedure: Adrenalectomy • coronary angiography • echocardiographySpecialty: Cardiology • Endocrinology and Metabolic • General and Internal MedicineObjective:Mistake in diagnosisBackground:Stress-induced cardiomyopathy is an increasingly recognized reversible cardiovascular condition. This type of cardiomyopathy usually occurs as an isolated event, and recurrent episodes are rare. Oftentimes, the underlying trigger is not recognized or definitively diagnosed. The differential diagnosis for reversible cardiomyopathy is extensive. A supraphysiologic catecholamine release from a pheochromocytoma can precipitate a recurrent and reversible cardiomyopathy. The highly variable clinical presentation of catecholamine-producing tumors can make timely recognition very challenging.Case Report:We present an exceptional case of recurrent reversible stress-induced cardiomyopathy triggered by an unrecognized pheochromocytoma with unusual clinical features. Our patient presented primarily with nonspecific neurological complaints, medication intolerance, and anxiety. The underlying etiology was not discovered until her fourth presentation of stress-induced cardiomyopathy.Conclusions:Pheochromocytomas can have a highly variable clinical presentation with a broad spectrum of signs and symptoms. Our case highlights the importance of performing an exhaustive search for a definitive underlying cause in the setting of recurrent “stress-induced” cardiomyopathy. Providers should consider an underlying catecholamine-producing tumor when presented with recurrent reversible cardiomyopathy. We recommend using plasma, rather than urine, catecholamine studies to screen for the presence of a pheochromocytoma.