Bidirectional ventricular tachycardia unmasked by beta-blockade in pheochromocytoma presenting as hypertensive optic neuropathy: a case report and literature review.
- 1Department of Cardiovascular Medicine, West China School of Medicine, Sichuan University; Sichuan University Affiliated Chengdu Second People's Hospital, Chengdu Second People's Hospital, Chengdu, Sichuan, China.
Abstract
Background
Pheochromocytoma is a catecholamine-secreting neuroendocrine tumor that can produce life-threatening cardiovascular complications. Bidirectional ventricular tachycardia (BVT) is a rare arrhythmia with a narrow differential diagnosis, classically associated with digitalis toxicity and catecholaminergic polymorphic ventricular tachycardia, and only exceptionally reported as the presenting feature of pheochromocytoma.Case presentation
A 51-year-old woman presented with acute visual impairment secondary to hypertensive optic neuropathy; her blood pressure was 220/138 mmHg. Within 24 h of initiating sodium nitroprusside and metoprolol, she developed bidirectional ventricular tachycardia followed by torsades de pointes. Marked blood-pressure lability, dramatically elevated plasma free metanephrines and catecholamines, and a left adrenal mass on computed tomography established the diagnosis of pheochromocytoma. After alpha-adrenergic blockade with phenoxybenzamine, laparoscopic adrenalectomy was performed, and histopathology confirmed the diagnosis. No ventricular arrhythmia recurred, and blood pressure normalized without antihypertensive medication.Conclusion
Bidirectional ventricular tachycardia may be the initial manifestation of pheochromocytoma and may be unmasked by beta-blockade administered before alpha-blockade. Unexplained BVT accompanied by blood-pressure fluctuations should prompt biochemical screening and adrenal imaging. Etiologic treatment is curative, whereas antiarrhythmic therapy alone is insufficient. We review the previously published cases to contextualize this rare phenotype.
Related
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- Global Advances in Ventricular Tachycardia Ablation
- NKX2-5 mutation in a family with ventricular tachycardia and aborted sudden cardiac death.
- Transatrial air-assisted epicardial ventricular tachycardia ablation for hypertrophic cardiomyopathy and management of postprocedural right atrial thrombus.
BibTeX
@article{xie2026bidirectional,
title = {{Bidirectional ventricular tachycardia unmasked by beta-blockade in pheochromocytoma presenting as hypertensive optic neuropathy: a case report and literature review.}},
author = {Jianhua Xie and Qin Yuxue and Hai Huang and Xiaojia Luo},
journal = {Frontiers in medicine},
year = {2026},
month = oct,
doi = {10.3389/fmed.2026.1942798},
url = {https://europepmc.org/article/MED/42923344},
note = {CC BY},
}
RIS
TY - JOUR
TI - Bidirectional ventricular tachycardia unmasked by beta-blockade in pheochromocytoma presenting as hypertensive optic neuropathy: a case report and literature review.
AU - Jianhua Xie
AU - Qin Yuxue
AU - Hai Huang
AU - Xiaojia Luo
PY - 2026
DA - 2026/10/08
JO - Frontiers in medicine
DO - 10.3389/fmed.2026.1942798
UR - https://europepmc.org/article/MED/42923344
AB - Background Pheochromocytoma is a catecholamine-secreting neuroendocrine tumor that can produce life-threatening cardiovascular complications. Bidirectional ventricular tachycardia (BVT) is a rare arrhythmia with a narrow differential diagnosis, classically associated with digitalis toxicity and catecholaminergic polymorphic ventricular tachycardia, and only exceptionally reported as the presenting feature of pheochromocytoma.Case presentation A 51-year-old woman presented with acute visual impairment secondary to hypertensive optic neuropathy; her blood pressure was 220/138 mmHg. Within 24 h of initiating sodium nitroprusside and metoprolol, she developed bidirectional ventricular tachycardia followed by torsades de pointes. Marked blood-pressure lability, dramatically elevated plasma free metanephrines and catecholamines, and a left adrenal mass on computed tomography established the diagnosis of pheochromocytoma. After alpha-adrenergic blockade with phenoxybenzamine, laparoscopic adrenalectomy was performed, and histopathology confirmed the diagnosis. No ventricular arrhythmia recurred, and blood pressure normalized without antihypertensive medication.Conclusion Bidirectional ventricular tachycardia may be the initial manifestation of pheochromocytoma and may be unmasked by beta-blockade administered before alpha-blockade. Unexplained BVT accompanied by blood-pressure fluctuations should prompt biochemical screening and adrenal imaging. Etiologic treatment is curative, whereas antiarrhythmic therapy alone is insufficient. We review the previously published cases to contextualize this rare phenotype.
SN - 2296-858X
ER -