Cardiac involvement in pheochromocytoma

We report the details of a 40-year-old farmer, a cigarette smoker, who was admitted with general malaise, nausea, vomiting, upper abdominal pain, with ST-elevation on ECG suggestive of an acute anterolateral myocardial infarc tion, He was treated with nitrates, heparin, beta-blockade and angiotensin- converting enzyme (ACE) inhibitors, Because of the presence of some blood w hile vomiting no thrombolysis was given and abdominal echography was perfor med, This revealed a nodular mass at the right adrenal gland. Urinary catec holamines and abdominal magnetic resonance imaging confirmed the suspected diagnosis of pheochromocytoma. Before adrenectomy, a coronary angiography u nder alpha blocker therapy was performed, which demonstrated no significant coronary artery disease, although the patient showed ST-elevations on EGG. Pathological examination of the adrenal tumor was compatible with a diagno sis of pheochromocytoma, Postoperatively urinary catecholamines dropped dra matically, and the ECG normalised slowly over time, After 8 months the pati ent is still well. Blood pressure is well controlled with no antihypertensi ve drugs and exercise testing shows no evidence of myocardial ischaemia.