hypertensive crisis

A 63-year-old female with cardiovascular risk factors presented with tremor, sweating, lower back discomfort, nausea and dyspnoea. Electrocardiogram showed sinus tachycardia with lateral ST-depression. High-sensitivity troponin-T was dynamically elevated (72ng/L to 112ng/L on one-hour repeat). Overnight, there was an episode of ventricular tachycardia with further troponin rise to 364ng/L. Coronary angiogram demonstrated non-obstructive coronary artery disease. Post-procedure, the patient developed a hypertensive crisis with pulmonary oedema (invasive blood pressure 350/140mmHg). This was managed with intravenous phentolamine. Ondansetron and metoclopramide were given for intractable vomiting. A pheochromocytoma was subsequently confirmed and surgically excised. Our experience in this case generated several important learning points that we hope may be of benefit to others who encounter suspected pheochromocytomas on the acute medical take.