Recurrent Takotsubo Cardiomyopathy due to Pheochromocytoma Managed With Venoarterial Extracorporeal Membrane Oxygenation

Pheochromocytoma-induced Takotsubo cardiomyopathy is a rare but life-threatening condition, caused by excessive plasma catecholamine levels, resulting in acute myocardial dysfunction. Clinical presentation includes a rapid development of heart failure due to regional wall motion abnormalities (most commonly affecting all mid to apical left ventricle (LV) wall segments) causing the "octopus-trap-like" LV shape. A 45-year-old female patient presented with acute cardiogenic shock of non-ischemic etiology. Her past medical history included a similar episode, which was followed by full recovery, but at this admission she required hemodynamic support with venoarterial extracorporeal membrane oxygenation. The systolic function was restored, and further investigation revealed high 24-h urine metanephrine levels and a mass of the left adrenal gland, leading to the diagnosis of pheochromocytoma. After treatment with firstly alpha-blockers and then beta-blockers, the pheochromocytoma was surgically removed.