Die Tako-Tsubo-Kardiomyopathie ähnelt in ihrer Symptomatik einem Myokardinfarkt – tritt aber bei gesunden Koronargefäßen auf. Ursache für die Funktionsstörung des Herzmuskels ist meist ein traumatisches Erlebnis, weshalb sie auch die Namen „Stress-Kardiomyopathie“ und „Broken Heart Syndrome“ trägt. In dem hier beschriebenen Fall war die Ursache allerdings an anderer Stelle zu suchen: nämlich an der Nebenniere.
Abstract
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.
Schlüsselwörter
Tako-Tsubo-Kardiomyopathie - Stressinduzierte Kardiomyopathie - Phäochromozytom - kardiogener Schock
Keywords
Tako-Tsubo cardiomyopathy - stress-induced cardiomyopathy - pheochromocytoma - cardiogenic shock
