Catecholamine-induced transient myocardial dysfunction.

This report presents an interesting case of acute myocardial stunning secondary to catecholamine surge from a phaeochromocytoma. A 39-year-old British Asian man was admitted with chest pain, labile blood pressure, dynamic ECG changes and positive troponin I level. Echocardiogram showed severe global impairment of his left ventricular systolic function but sparing of the basal segments. Portable renal ultrasonography revealed a 6 cm mass in the left adrenal gland. The clinical suspicion was of catecholamine-induced acute myocardial dysfunction secondary to underlying phaeochromocytoma. Intravenous alpha blockade resulted in a dramatic clinical improvement and near resolution of the echocardiographic abnormalities. Subsequent coronary angiography confirmed normal coronary arteries. He was discharged, well, on oral alpha-adrenergic and beta-adrenergic blockade. Outpatient metaiodobenzylguanidine scanning was consistent with the diagnosis and a left phaeochromocytoma was successfully removed laparoscopically.