Chest Pain and Tachycardia: Is It Pheochromocytoma? - Cardiology

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Chest pain and tachycardia can be concerning symptoms that often lead to a thorough evaluation to rule out serious underlying conditions. In your case, you have undergone a nuclear stress test that indicated 95% patency of your coronary arteries, and your echocardiogram results were normal. However, you are experiencing persistent chest pain and an elevated heart rate of 110 beats per minute, along with a VMA (vanillylmandelic acid) level of 9.1 mg/24 hours, which is above the normal threshold of 7.5 mg.

Pheochromocytoma is a rare tumor of the adrenal glands that can secrete catecholamines (such as epinephrine and norepinephrine), leading to symptoms like paroxysmal hypertension, palpitations, sweating, and headaches. The elevated VMA level you reported is significant because VMA is a metabolite of catecholamines. In patients with pheochromocytoma, VMA levels can be elevated due to excessive catecholamine production.

Given your symptoms and the elevated VMA level, it is reasonable to consider pheochromocytoma as a potential diagnosis. However, it is essential to interpret these findings in the context of your overall clinical picture. The fact that your heart scans are normal and that you have no significant coronary artery disease is reassuring, but it does not entirely rule out other causes of your symptoms.

Persistent chest pain that lasts throughout the day is less typical for angina, which usually occurs with exertion and resolves with rest. This raises the possibility that your chest pain may not be cardiac in origin. Non-cardiac causes of chest pain can include gastrointestinal issues (such as gastroesophageal reflux disease), musculoskeletal problems, or even anxiety-related disorders.
To further evaluate your condition, it would be prudent to follow up with an endocrinologist, who can assess the possibility of pheochromocytoma more thoroughly. This may involve additional imaging studies, such as a CT scan or MRI of the adrenal glands, to look for any tumors. Additionally, other tests may be performed to rule out other causes of your symptoms.

In summary, while your elevated VMA level raises the suspicion for pheochromocytoma, it is crucial to consider the entire clinical picture, including your normal cardiac evaluations. A multidisciplinary approach involving both cardiology and endocrinology may provide the best pathway to a definitive diagnosis and appropriate management. If you continue to experience chest pain or other concerning symptoms, do not hesitate to seek immediate medical attention.