Acute and Critical Care

Case Reports

Cardiology
Successful extracorporeal membrane oxygenation treatment of catecholamine-induced cardiomyopathy-associated pheochromocytoma: a case report: Sangshin Park, Min Kim, Dae In Lee, Ju-Hee Lee, Sangmin Kim, Sang Yeub Lee, Jang-Whan Bae, Kyung-Kuk Hwang, Dong-Woon Kim, Myeong-Chan Cho, Dae-Hwan Bae; Acute Crit Care. 2024;39(1):194-198. Published online May 11, 2022; DOI: https://doi.org/10.4266/acc.2021.01158

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The main mechanism of Takotsubo cardiomyopathy (TCM) is catecholamine-induced acute myocardial stunning. Pheochromocytoma, a catecholamine-secreting tumor, can cause several cardiovascular complications, including hypertensive crisis, myocardial infarction, toxic myocarditis, and TCM. A 29-year-old woman presented to our hospital with general weakness, vomiting, dyspnea, and chest pain. The patient was nullipara, 28 weeks’ gestation, and had a cachexic morphology. Her cardiac enzyme levels were elevated and bedside echocardiography showed apical akinesia, suggesting TCM. The next day, she could not feel the fetal movement, and an emergency cesarean section was performed. After delivery, the patient experienced cardiac arrest and was transferred to the intensive care unit for cardiopulmonary resuscitation (CPR). Spontaneous circulation returned after 28 minutes of CPR, but cardiogenic shock continued, and extracorporeal membrane oxygenation (ECMO) was initiated. On the third day of ECMO maintenance, left ventricular ejection fraction improved and blood pressure stabilized. On the eighth day after ECMO insertion, it was removed. However, complications of the left leg vessels occurred, and several surgeries and interventions were performed. A left adrenal gland mass was found on computed tomography and was removed while repairing the leg vessels. Pheochromocytoma was diagnosed and left adrenalectomy was performed.

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Mechanical Circulatory Support Strategies in Takotsubo Syndrome with Cardiogenic Shock: A Systematic Review
Johanna K. R. von Mackensen, Vanessa I. T. Zwaans, Ahmed El Shazly, Karel M. Van Praet, Roland Heck, Christoph T. Starck, Felix Schoenrath, Evgenij V. Potapov, Joerg Kempfert, Stephan Jacobs, Volkmar Falk, Leonhard Wert
Journal of Clinical Medicine.2024; 13(2): 473. CrossRef

Cardiology
Catecholamine-Induced Cardiomyopathy associated with Neuroblastoma and Treated with Extracorporeal Membrane Oxygenation as a Bridge to Recovery: Junggu Yi, Si Oh Kim, Jun-mo Park, Sung-hye Byun, Hoon Jung, Seong Wook Hong; Korean J Crit Care Med. 2015;30(4):299-302. Published online November 30, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.4.299

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Abstract PDF

Catecholamine-induced cardiomyopathy associated with neuroblastoma is rarely reported. We report a case of catecholamine-induced cardiomyopathy associated with neuroblastoma in a 33-month-old female that was treated with extracorporeal membrane oxygenation (ECMO). She was tentatively diagnosed with acute myocarditis and presented with hypertension. Because of rapid patient deterioration despite pharmacological treatments, ECMO was applied. ECMO can be helpful in cases of catecholamine-induced cardiomyopathy associated with neuroblastoma.

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COVID-19 and cardiovascular disease: manifestations, pathophysiology, vaccination, and long-term implication
Adel Abdel Moneim, Marwa A. Radwan, Ahmed I. Yousef
Current Medical Research and Opinion.2022; 38(7): 1071. CrossRef

Stress Related Cardiomyopathy during Flexible Bronchoscopy: Jung Ar Shin, Ji Yoon Ha, Sang Yong Kim, Byoung Kwon Lee, Hyung Jung Kim, Chul Min Ahn, Yoon Soo Chang; Korean J Crit Care Med. 2013;28(2):127-132.; DOI: https://doi.org/10.4266/kjccm.2013.28.2.127

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Abstract PDF: Flexible bronchoscopy is a safe medical procedure, but the incidence rate of major complications is 0.08-0.3%. Here, we report 2 cases of stress induced cardiomyopathy, which developed immediately after flexible bronchoscopy. Stress related cardiomyopathy was confirmed by EKG, echocardiography, and coronary angiogram. The cardiac functions of these patients were fully recovered with conservative treatment. Although, the pathogenesis of stress related cardiomyopathy is not well understood, post-bronchoscopy tachycardia or arrhythmia is thought to be associated with hypoxemia or catecholamine excess. Because the clinical presentation is quite similar to acute myocardial infarction, discrete evaluations are required for appropriate treatment.

Takotsubo Cardiomyopathy Induced after Postoperative ICU Care: Case Reports: Kuk Hui Son, Jae Seung Jung, Kwang Taik Kim, Kyung Sun, Ho Sung Son, Jae Yoon Song, Yong Hyun Kim, Sung Ho Lee; Korean J Crit Care Med. 2009;24(3):152-155.; DOI: https://doi.org/10.4266/kjccm.2009.24.3.152

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Abstract PDF

'Takotsubo cardiomyopathy' or 'stress-induced cardiomyopathy' is a newly described clinical entity that's characterized by transient left ventricular apical ballooning and left ventricular apical dyskinesis in the absence of any angiographic feature of significant coronary artery disease. The cause of takotsubo cardiomyopathy is unclear, but catecholamines probably play a role in the genesis of takotsubo cardiomyopathy. We report here on two cases of takotsubo cardiomyopathy that occurred during ICU care.

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Stress-induced Cardiomyopathy Following Cesarean Delivery with Hemorrhagic Shock - A Case Report -
Youn Yi Jo, Ja Young Kwon, Yoon-Seong Jang, Yong Seon Choi
The Korean Journal of Critical Care Medicine.2011; 26(1): 34. CrossRef

Randomized Controlled Trial

Effects of Alfentanil on Hemodynamic and Catecholamine Responses to Laryngoscopy and Endobronchial Intubation in the Elderly: Kyung Yeon Yoo, Sung Su Chung, Myung Ha Yoon, Seong Wook Jeong, Jeong Il Choi, Chang Young Jeong; Korean J Crit Care Med. 2005;20(2):114-120.

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Abstract PDF: BACKGROUND
Endobronchial intubation should elicit significant circulatory responses. We examined the effects of alfentanil on hemodynamic and catecholamine responses to endobronchial intubation in elderly patients. METHODS: A total of 60 patients aged over 60 years requiring endobronchial intubation were randomized into three groups of 20 patients each. Anesthesia was induced with thiopental 4~6 mg/kg followed by saline (placebo) or alfentanil 10 or 30microgram/kg given as a bolus over 30 s. Succinylcholine 1 mg/kg was given for neuromuscular block. Laryngoscopy and intubation were performed 1 min later. RESULTS: The intubation significantly increased systolic arterial pressure and heart rate. The maximum pressure changes from pre-intubation values in both alfentanil groups (58+/-27 and 33+/-30 mm Hg in 10 and 30microgram/kg, respectively) were significantly lower compared with that of 83+/-35 mm Hg in the control group. The tachycardiac response was not significantly affected by alfentanil 10microgram/kg, but attenuated by alfentanil 30microgram/kg. The plasma norepinephrine concentrations were increased, which was not affected by alfentanil 10microgram/kg, but was significantly attenuated by alfentanil 30microgram/kg. Both doses of alfentanil abolished the increase of plasma epinephrine concentrations. Three patients in the 30microgram/kg group received ephedrine for hypotension. CONCLUSIONS: This study showed that endobronchial intubation elicited significant pressor response, and that alfentanil 30microgram/kg is more efficacious in attenuating the hemodynamic and catecholamine responses, although potential hypotension warrants a caution of its use, in elderly patients.

Original Article

Changes of Heart Rate, Blood Pressure, and Plasma Catecholamine Levels in Rabbits during the Apneic Oxygenation: Seung Eun Oh, Hyun Jeong Kim, Kwang Won Yum; Korean J Crit Care Med. 2001;16(1):30-35.

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Abstract PDF: BACKGROUND
Permissive hypercapnia and apneic oxygenation are used to provide oxygen to patient without active ventilation. It is well known that hypercapnia induces the release of endogenous catecholamines. However, it is unclear that how much or what kind of catecholamines are released. The aim of this study was to observe changes of basic hemodynamic parameters and plasma catecholamine concentration during apneic oxygenation.
METHODS
Twenty-one rabbits weighing 2.0~3.0 kg were anesthetized with 100% oxygen and isoflurane. 0.05 mg/kg of atropine was injected and endotracheal intubation was done. 1 mg/kg/hr of vecuronium was infused during the experiment. The anesthesia and apneic oxygenation was maintained with 100% oxygen and 2 vol% isoflurane under 1 cmH2O PEEP using continuous positive airway pressure device. During the apneic oxygenation, blood pressure, heart rate, and plasma catecholamine concentration were measured every 10 min using High Performance Liquid Chromatography.
RESULTS
Systolic blood pressure was significantly increased but diastolic blood pressure was not changed until post-apneic 40 min. After then, both systolic and diastolic blood pressure were significantly decreased. At post-apneic 10 min, heart rate was dramatically decreased and slowly recovered to the level of control data until post-apneic 60 min. Plasma epinephrine level was increased higher than that of norepinephrine by 3 to 4 times.
CONCLUSIONS
Epinephrine may play more important role than norepinephrine to compensate the cardiovascular depressive effects of hypercapnia during the apneic oxygenation in rabbits.

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