Author + information
- Received December 4, 2019
- Revision received March 11, 2020
- Accepted April 2, 2020
- Published online July 20, 2020.
- Matthew A. Nazari, MDa,b@NazariMatthew,
- Jared S. Rosenblum, MDc,
- Mark C. Haigney, MDd,e,
- Douglas R. Rosing, MDe,f and
- Karel Pacak, MD, PhD, DSca,∗ ()
- aSection on Medical Neuroendocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
- bDepartment of Internal Medicine and Pediatrics, MedStar Georgetown University Hospital, Washington, DC
- cNeuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
- dDivision of Cardiology, Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- eDivision of Cardiology, Department of Medicine, Walter Reed National Military Medical Center, and Herbert School of Medicine, Bethesda, Maryland
- fCardiovascular Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
- ↵∗Address for correspondence:
Dr. Karel Pacak, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Building 10, CRC, Room 1E-3140, 10 Center Drive MSC-1109, Bethesda, Maryland 20892-1109.
• Pheochromocytomas cause life-threatening tachyarrhythmias; however, no up-to-date published data exists about their management.
• Understanding catecholamine physiology ensures appropriate intervention while avoiding mismanagement and consequent poor cardiovascular outcomes.
• Cardiologists are pivotal in implementing up-to-date care for pheochromocytoma-induced tachyarrhythmias.
• Additional studies are needed to further optimize management strategies of pheochromocytoma-induced tachyarrhythmias.
Pheochromocytomas, arising from chromaffin cells, produce catecholamines, epinephrine and norepinephrine. The tumor biochemical phenotype is defined by which of these exerts the greatest influence on the cardiovascular system when released into circulation in high amounts. Action on the heart and vasculature can cause potentially lethal arrhythmias, often in the setting of comorbid blood pressure derangements. In a review of electrocardiograms obtained on pheochromocytoma patients (n = 650) treated at our institution over the last decade, severe and refractory sinus tachycardia, atrial fibrillation, and ventricular tachycardia were found to be the most common or life-threatening catecholamine-induced tachyarrhythmias. These arrhythmias, arising from catecholamine excess rather than from a primary electrophysiologic substrate, require special considerations for treatment and complication avoidance. Understanding the synthesis and release of catecholamines, the adrenoceptors catecholamines bind to, and the cardiac and vascular response to epinephrine and norepinephrine underlies optimal management in catecholamine-induced tachyarrhythmias.
- blood pressure
- sinus tachycardia
- ventricular tachycardia
This work was supported by the intramural research programs of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Cancer Institute, and National Heart, Lung, and Blood Institute, National Institutes of Health. All authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC author instructions page.
- Received December 4, 2019.
- Revision received March 11, 2020.
- Accepted April 2, 2020.
- 2020 American College of Cardiology Foundation
This article requires a subscription or purchase to view the full text. If you are a subscriber or member, click Login or the Subscribe link (top menu above) to access this article.