{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T04:59:32Z","timestamp":1788325172813,"version":"build-2803163510"},"reference-count":13,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2021,3,22]],"date-time":"2021-03-22T00:00:00Z","timestamp":1616371200000},"content-version":"vor","delay-in-days":22,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,2,28]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>A \u2018catecholamine storm\u2019 in a case of pheochromocytoma can lead to a transient left ventricular dysfunction similar to Takotsubo cardiomyopathy. A cardiogenic shock can thus develop, with high left ventricular end-diastolic pressure and a reduction in coronary perfusion pressure. This scenario can ultimately lead to a cardiac arrest, in which unloading the left ventricle with a peripheral left ventricular assist device (Impella\u00ae) could help in achieving the return of spontaneous circulation (ROSC).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Case summary<\/jats:title>\n                  <jats:p>A patient affected by Takotsubo cardiomyopathy caused by a pheochromocytoma presented with cardiogenic shock that finally evolved into refractory cardiac arrest. Cardiopulmonary resuscitation was performed but ROSC was achieved only after Impella\u00ae placement.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>In the clinical scenario of Takotsubo cardiomyopathy due to pheochromocytoma, when cardiogenic shock develops treatment is difficult because exogenous catecholamines, required to maintain organ perfusion, could exacerbate hypertension and deteriorate the cardiomyopathy. Moreover, as the coronary perfusion pressure is critically reduced, refractory cardiac arrest could develop. Although veno-arterial extra-corporeal membrane oxygenation (va-ECMO) has been advocated as the treatment of choice for in-hospital refractory cardiac arrest, in the presence of left ventricular overload a device like Impella\u00ae, which carries fewer complications as compared to ECMO, could be effective in obtaining the ROSC by unloading the left ventricle.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytab092","type":"journal-article","created":{"date-parts":[[2021,3,22]],"date-time":"2021-03-22T11:55:37Z","timestamp":1616414137000},"source":"Crossref","is-referenced-by-count":9,"title":["Cardiac arrest complicating cardiogenic shock: from pathophysiological insights to Impella-assisted cardiopulmonary resuscitation in a pheochromocytoma-induced Takotsubo cardiomyopathy\u2014a case report"],"prefix":"10.1093","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7217-4961","authenticated-orcid":false,"given":"Filippo","family":"Zilio","sequence":"first","affiliation":[{"name":"Department of Cardiology, Santa Chiara Hospital, 2, Largo Medaglie d\u2019Oro, 38122 Trento, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1535-8502","authenticated-orcid":false,"given":"Simone","family":"Muraglia","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Santa Chiara Hospital, 2, Largo Medaglie d\u2019Oro, 38122 Trento, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7882-0709","authenticated-orcid":false,"given":"Roberto","family":"Bonmassari","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Santa Chiara Hospital, 2, Largo Medaglie d\u2019Oro, 38122 Trento, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,3,22]]},"reference":[{"key":"2021071002563446100_ytab092-B1","doi-asserted-by":"crossref","first-page":"1438","DOI":"10.1136\/heartjnl-2013-304073","article-title":"Acute catecholamine cardiomyopathy in patients with phaeochromocytoma or functional paraganglioma","volume":"99","author":"Giavarini","year":"2013","journal-title":"Heart"},{"key":"2021071002563446100_ytab092-B2","doi-asserted-by":"crossref","first-page":"2032","DOI":"10.1093\/eurheartj\/ehy076","article-title":"International Expert Consensus Document on Takotsubo Syndrome (Part I): Clinical characteristics, diagnostic criteria, and pathophysiology","volume":"39","author":"Ghadri","year":"2018","journal-title":"Eur Heart J"},{"key":"2021071002563446100_ytab092-B3","doi-asserted-by":"crossref","first-page":"1523","DOI":"10.1093\/eurheartj\/ehl032","article-title":"Apical ballooning syndrome or takotsubo cardiomyopathy: a systematic review","volume":"27","author":"Gianni","year":"2006","journal-title":"Eur Heart J"},{"key":"2021071002563446100_ytab092-B4","first-page":"20472047","article-title":"International Expert Consensus Document on Takotsubo Syndrome (Part II): Diagnostic workup, outcome, and management","volume":"39","author":"Ghadri","year":"2018","journal-title":"Eur Heart J"},{"key":"2021071002563446100_ytab092-B5","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1007\/s12020-013-0007-y","article-title":"Anti-hypertensive treatment in pheochromocytoma and paraganglioma: current management and therapeutic features","volume":"45","author":"Mazza","year":"2014","journal-title":"Endocrine"},{"key":"2021071002563446100_ytab092-B6","doi-asserted-by":"crossref","first-page":"2118","DOI":"10.1093\/eurheartj\/ehx812","article-title":"Haemodynamic deterioration due to intra-aortic balloon counterpulsation in takotsubo cardiomyopathy","volume":"39","author":"Sangen","year":"2018","journal-title":"Eur Heart J"},{"key":"2021071002563446100_ytab092-B7","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1093\/ehjcr\/ytz195","article-title":"Reverse takotsubo cardiomyopathy - 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