The Ultimate Case of Catecholaminergic Cardiomyopathy: Phaeochromocytoma-Induced Reverse Takotsubo Cardiomyopathy

Abstract

Catecholamine-induced cardiomyopathy relies on a complex mix of neurohormonal and cardiomyocytes-specific factors. The incidence of catecholamine-secreting tumours on patients with Takotsubo cardiomyopathy has been quoted to be as high as 7.5% in some retrospective series. We present the case of a 39-year-old female initially presenting with ST elevation myocardial infarction without evidence of coronary artery disease and the subsequent finding of reverse Takotsubo cardiomyopathy on echocardiography. This patient's presentation was complicated by cardiogenic shock requiring extracorporeal membrane oxygenation and the subsequent diagnosis of a phaeochromocytoma on computer tomography imaging and endocrinological biochemistry. Reverse Takotsubo cardiomyopathy is a variant of Takotsubo cardiomyopathy characterised by hyperdynamic function of the left ventricular (LV) apex and basal akinesis. Interestingly, this pattern of stress-induced cardiomyopathy may relate to the distribution of beta adrenergic receptors across the adult myocardium with peak adrenergic receptor density being present at the apex of the heart in adulthood. Reverse Takotsubo cardiomyopathy can differ in its presentation, haemodynamic effects, and prognosis compared with classical stress-induced cardiomyopathy. We aim to explore the rare clinical entity that is reverse Takotsubo cardiomyopathy and the subsequent involvement of the adrenergic cascade in the pathogenesis of left ventricular dysfunction in this subpopulation.