Case Presentation A 27 year old male presented with shortness of breath and sweating and on examination had signs of heart failure. An echocardiogram showed global akinesia and an ejection fraction of 15%. He was diagnosed with dilated cardiomyopathy secondary to viral infection and commenced on medical treatment. During a routine cardiology clinic visit he became hypotensive with a systolic BP of 60 mmhg and diaphoretic, his ECG showed sinus rhythm. He was admitted for investigations and noted to have a fluctuating BP with a peak of 203 systolic which raised the suspicion of pheochromocytoma. Urine catecholamines confirmed this diagnosis with raised noradrenaline levels and a subsequent CT showed a large left Para-aortic mass and MIBG showed increased focal uptake corresponding to this mass. He was commenced on alpha-blockade followed by beta blockade and underwent successful surgical resection of the tumour. The histology showed paraganglioma -extra-adrenal pheochromocytoma. He is now well post-operatively and an echocardiogram 1 year following surgery has shown full recovery of his cardiac function. Discussion Excess catecholamines are known to cause myocarditis by increasing the sacrommemmal membrane permeability leading to intracellular calcium influx which has a toxic effect. Oxidative products aswell as free radicals are also thought to be toxic to the myocardium. Further more catecholamines have a positive chronotropic and inotropic effect aswell as increasing the peripheral vascular resistance, the net effect being increasing workload on the myocardium. This can lead to dilated cardiomyopathy or hypertrophic cardiomyopathy in response to hypertension. This case highlights the need to screen for pheochromocytoma in any patient with unexplained dilated cardiomyopathy especially as the damage is reversible as illustrated in our patient.
Declaration of interest: There is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.
Funding: No specific grant from any funding agency in the public, commercial or not-for-profit sector.