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嗜铬细胞瘤相关性心肌病表现为急性心肌梗死:病例报告。

Pheochromocytoma-related cardiomyopathy presenting as acute myocardial infarction: A case report.

机构信息

Intensive Care Unit, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou.

Intensive Care Unit, Dongyang People's Hospital, Dongyang, Zhejiang, PR China.

出版信息

Medicine (Baltimore). 2021 Mar 19;100(11):e24984. doi: 10.1097/MD.0000000000024984.

Abstract

INTRODUCTION

Pheochromocytoma (PHEO)-related cardiomyopathy is a rare condition in which release of a large amount of catecholamines leads to severe vasoconstriction, coronary vasospasm, myocardial ischemia, injury, and necrosis. Its clinical manifestations can be similar to those of acute coronary syndrome.

PATIENT CONCERNS

A 63-year-old woman was diagnosed with acute non-ST segment elevation myocardial infarction following chest pain for 8 hours. The results of coronary angiography were normal. The patient developed dyspnea, cough with frothy pink sputum, paroxysmal sweating, arrhythmia, and blood pressure fluctuation, and was transferred to the intensive care unit for monitoring and treatment.

DIAGNOSIS

PHEO, catecholamine cardiomyopathy (CICMP).

INTERVENTION

After monitoring the pulse index continuous cardiac output and treatment with α and β adrenergic receptor blockers for 18 days, laparoscopic resection of the left adrenal mass was performed.

OUTCOMES

The patient's condition improved and she was discharged 31 days after admission. Outpatient follow-up examinations 1 month and 1 year later did not show recurrence.

LESSONS

PHEO can cause CICMP, the manifestations of which are partly similar to those of takotsubo cardiomyopathy (TTC). Once the patient's condition stabilizes, surgery should be considered. Fluid management is necessary, and agents such as α and β adrenergic receptor blockers should be administered.

摘要

简介

嗜铬细胞瘤(PHEO)相关性心肌病是一种罕见病症,大量儿茶酚胺的释放会导致严重的血管收缩、冠状动脉痉挛、心肌缺血、损伤和坏死。其临床表现可能与急性冠状动脉综合征相似。

病例介绍

一位 63 岁女性因胸痛 8 小时后被诊断为急性非 ST 段抬高型心肌梗死。冠状动脉造影结果正常。患者出现呼吸困难、咳嗽伴泡沫状粉红色痰、阵发性出汗、心律失常和血压波动,并被转至重症监护病房进行监测和治疗。

诊断

嗜铬细胞瘤,儿茶酚胺性心肌病(CICMP)。

干预措施

在监测脉搏指数连续心输出量并使用α和β肾上腺素能受体阻滞剂治疗 18 天后,进行了腹腔镜左肾上腺肿块切除术。

结果

患者病情改善,入院 31 天后出院。1 个月和 1 年后的门诊随访检查未显示复发。

教训

嗜铬细胞瘤可引起 CICMP,其表现部分与应激性心肌病(TTC)相似。一旦患者病情稳定,应考虑手术。需要进行液体管理,并应给予α和β肾上腺素能受体阻滞剂等药物。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1cf1/7982151/62cea9e9d2d4/medi-100-e24984-g001.jpg

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