Anginalike pain and normal coronary arteries

Recurrent angina and cardiac ischaemia as a presentation of pheochromocytoma: a case report

Background

We present a case of a pregnant patient with recurrent angina, in which her symptoms were initially attributed to coronary artery spasm. However, during follow-up, she was diagnosed as having pheochromocytoma, a rare neuroendocrine tumour.

Case summary

The 35-year-old patient was admitted to the hospital because of chest pain and elevated cardiac troponins after the use of MDMA. Physical examination, electrocardiogram, echocardiography, coronary angiogram, and cardiac MRI were normal. Symptoms were attributed to coronary spasm, and a calcium antagonist was started. Ten months later, when 36 weeks pregnant, her symptoms returned. One week later, the patient was readmitted to the hospital with signs of acute left ventricular (LV) failure, highly elevated troponins, and severe global LV dysfunction. Urgent section caesarean was performed due to maternal morbidity and foetal tachycardia. During section, flushes and marked variability in blood pressure were noted. Laboratory metanephrines testing was performed. LV function recovered within 3 days without any therapeutic intervention. However, chest pain reoccurred, now accompanied with headaches, malignant hypertension, and accelerated idiopathic ventricular rhythms. (Nor)metanephrines tests were positive. A solid lesion in the right adrenal on CT scan confirmed the diagnosis of pheochromocytoma. Fluid repletion and alpha-blocker therapy were started. Due to persistent symptoms, urgent laparoscopic adrenalectomy was performed. Hereafter, the patient remained without symptoms.

Discussion

A pheochromocytoma may present with recurrent angina and can result in a catecholamine-induced cardiomyopathy. It is important to timely recognize this diagnosis in order to minimize morbidity and mortality.

Efficacy of functional relaxation and patient education in the treatment of somatoform heart disorders: a randomized, controlled clinical investigation

BACKGROUND

Recurrent heart problems and, especially, chest pain in the absence of somatic heart disease is a common finding, although challenging to treat.

OBJECTIVE

The authors assessed a body-oriented approach to the somatic fixation frequently seen in these patients.

METHOD

They conducted a controlled study to assess the effect of functional relaxation in 22 patients with non-specific chest pain. The primary outcome measures were self-reported changes on the subscales Somatization and Anxiety of the Symptom Checklist of Derogatis, as well as the subscale Cardiovascular Complaints of the Giessen Inventory of Complaints.

RESULTS

Significant improvements of the primary outcome measures were observed in patients treated with functional relaxation, whereas no significant improvements could be seen in the control group.

CONCLUSION

Functional relaxation appears to be a safe and effective, non-pharmacological approach in the treatment of non-specific chest pain.