[Cardiogenic shock due to atypical Tako-Tsubo cardiomyopathy in a young woman with pheochromocytoma].

HISTORY AND CLINICAL FINDINGS

A 42-year old female patient was admitted in cardiogenic shock with pulmonary edema requiring prehospital intubation and mechanical ventilation.

INVESTIGATIONS

| Emergency cardiac catheterization because of suspected acute coronary syndrome excluded coronary artery disease. Ventriculography and echocardiography suggested an inverse Tako-Tsubo cardiomyopathy with akinesia of the basal left ventricular myocardium and only apical preserved wall motion.

TREATMENT AND COURSE

Under intensive care therapy with mechanical ventilation, inotropic support, infusion of saline and intraaortal balloon pumping, left ventricular function improved. After discontinuation of mechanical ventilation and discharge from ICU, the patient repeatedly suffered from panic attacks. She was therefore transferred to a psychosomatic center. There she exhibited repeated hypertensive crisis. Ultrasound of the kidney showed an adrenal mass. Together with elevated plasma catecholamines, the diagnosis of pheochromocytoma was suspected. This could be proved by magnetic resonance imaging. After surgical removement of the adrenal mass, the patient was free of symptoms.