Cardiovascular Presentation in Pheochromocytoma: What We Should be Aware

Pheochromocytoma is a catecholamine-producing tumor that although being a rare disease, it poses diagnostic problems because its clinical presentation often mimics certain diseases, including cardiovascular disorders. The effects of excessive catecholamine secretion cause a variety of cardiovascular presentations ranging from hypertension to life-threatening cases such as hypertensive emergency, shock, supraventricular or ventricular arrhythmias, pulmonary edema, and acute coronary syndromes. The principal medical treatment for pheochromocytoma is a blockade of adrenergic receptors. However, surgical or tumor resection often provides complete resolution of abnormal myocardial dysfunction or arrhythmias, so this approach remains the mainstay of treatment that should be performed as soon as the diagnosis of pheochromocytoma is established. As clinicians, we must be aware of the characteristics of the cardiovascular manifestations of pheochromocytoma to make an earlier diagnosis and more appropriate management.

Cardiac Metabolism in Sepsis

The mechanism of sepsis-induced cardiac dysfunction is believed to be different from that of myocardial ischemia. In sepsis, chemical mediators, such as endotoxins, cytokines, and nitric oxide, cause metabolic abnormalities, mitochondrial dysfunction, and downregulation of β-adrenergic receptors. These factors inhibit the production of ATP, essential for myocardial energy metabolism, resulting in cardiac dysfunction. This review focuses on the metabolic changes in sepsis, particularly in the heart. In addition to managing inflammation, interventions focusing on metabolism may be a new therapeutic strategy for cardiac dysfunction due to sepsis.