Bidirectional ventricular tachycardia and cardiogenic shock caused by acute haemorrhagic necrosis of pheochromocytoma: a case report

TL;DR

A rare case of heart failure and a dangerous heart rhythm was caused by a bleeding adrenal tumor, highlighting the importance of early diagnosis.

Contribution

This case report highlights the rare but critical association between bidirectional ventricular tachycardia and acute pheochromocytoma hemorrhage.

Findings

Bidirectional ventricular tachycardia and cardiogenic shock were observed in a patient with acute pheochromocytoma hemorrhage.

Early diagnosis and treatment with alpha–beta blockade improved patient outcomes.

BVT may serve as a key indicator for identifying acute pheochromocytoma complications.

Abstract

Pheochromocytoma is associated with serious cardiovascular complications resulting from the effect of catecholamines, such as ventricular arrhythmias, cardiomyopathy with left ventricular dysfunction, and cardiogenic shock. Bidirectional ventricular tachycardia (BVT) is a rare but potentially fatal form of polymorphic tachycardia associated with elevated sympathetic tone.

A 27-year-old Caucasian woman was admitted to the intensive care unit with cardiogenic shock. The electrocardiogram showed BVT, and the transthoracic echocardiogram showed a dilated left ventricle with severe systolic dysfunction. Computed tomography revealed an adrenal mass with haemorrhage, which was confirmed by abdominal magnetic resonance imaging. The patient underwent a laparoscopic right adrenalectomy after pre-operative preparation with alpha–beta blockade, with subsequent histopathological confirmation of the diagnosis.

The acute presentation of haemorrhagic necrosis of a pheochromocytoma is a rare and potentially lethal condition. Its diagnosis can be challenging, especially in cases with atypical manifestations. However, the presence of BVT might serve as a crucial guide for its identification. Early recognition of this condition is essential, as it significantly impacts the patient's prognosis.

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