Author(s): Agarwal V, Kant G, Hans N, Messerli FH
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Abstract BACKGROUND: Takotsubo Cardiomyopathy (TTC) is commonly triggered by acute illness, physical or emotional stress and has been associated with elevated catecholamine levels. TTC has also been associated with pheochromocytoma (TTC-pheo). METHODS: We performed a computer assisted search of the electronic databases Medline, Scopus and Google Scholar from 1965 to January 2011. All case reports with reported TTC-pheo were selected and compared to a recent review by Gianni et al. which examined primary TTC (TTC-primary). STATISTICS: Data analysis was performed using SPSS version 18. Chi-square test of Fisher's exact test was used as appropriate to compare categorical data. RESULTS: 38 cases of TTC-pheo were retrieved from literature and compared to 254 cases of TTC-p. Chest pain was the most common presentation in both groups. The TTC-pheo patients were on average 18 years younger than patients with TTC-p (p<0.01). Only a minority of TTC-pheo patients presented with classical features of pheochromocytoma including hypertension (52.6\%), headache (28.9\%), palpitations (31.6 \%), and diaphoresis (26.3\%). In TTC-pheo complications rates were higher compared to TTC-p, including cardiogenic shock (34.2\% vs. 4.2\%, p<0.01) and heart failure (46.7\% vs. 17.7\%, p<0.01). Antecedent stressors were less common in TTC-pheo. About one-third of TTC-pheo patients presented with the inverted pattern, which compared to the apical pattern, was associated with higher complication rates, including, cardiogenic shock, heart failure, acute renal failure and arrhythmias. CONCLUSIONS: Although rare, pheochromocytoma should be considered in the differential diagnosis of TTC especially in younger patients presenting without antecedent stressors and a high complication rate. The similarities in the clinical features and outcomes in patients with TTC-p and TTC-pheo point to a similar underlying cardiac pathophysiologic process at the time of the acute presentation. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.
This article was published in Int J Cardiol
and referenced in Journal of Microbial & Biochemical Technology