Acute Subarachnoid Hemorrhage and Cardiac Abnormalities: Takotsubo Cardiomyopathy or Neurogenic Stunned Myocardium? a case report

Franco, Carlos; Khaled, B; Afonso, Luís; Raufi, M. Adnan

doi:10.1186/1757-1626-3-81

Cited by 19 publications

(10 citation statements)

References 5 publications

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“…In contrast to the classical description of takotsubo syndrome involving the apical and distal walls of the left ventricle, variants of neurogenic-stunned myocardium have been described in SAH where the basal and middle ventricular portions of the anteroseptal and anterior walls are involved 9 10. While most of the patients will remain poorly symptomatic, some will develop acute heart failure.…”

Section: Discussionmentioning

confidence: 95%

High-dose insulin therapy for neurogenic-stunned myocardium after stroke

et al. 2012

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A 44-year-old woman with a history of complicated type 2 diabetes mellitus presented with a diagnosis of right-hemispheric ischaemic stroke. She developed acute respiratory distress with radiological evidence of pulmonary oedema. The ECG showed poorly significant ST-segment changes, with a minimal increase of cardiac biomarkers. Echocardiography showed a severely depressed left ventricular function, with also low values of cardiac output at invasive monitoring. The possibility of neurogenic-stunned myocardium was discussed and a metabolic resuscitation with high-dose insulin was proposed. An intravenous bolus of 80 units of insulin (0.72 IU/kg) was followed by a continuous infusion at the rate of 160 IU/h (1.45 IU/kg/h). The treatment led to a rapid and sustained improvement of the haemodynamic condition and was well tolerated. In comparison with dobutamine, insulin had significant inotropic effects without tachycardia. The patient unfortunately died on day 35, from respiratory complications after poor neurological recovery. BACKGROUND

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Section: Discussionmentioning

confidence: 95%

High-dose insulin therapy for neurogenic-stunned myocardium after stroke

et al. 2012

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“…To our knowl edge, there are tree se ries of SAH pa tients with TCM and few case re ports [7][8][9][10][11][12][13] . The in ci dence of TCM in SAH is 0.8-6% 8,9 .…”

Section: Discussionmentioning

confidence: 99%

Stress-induced cardiomyopathy in aneurysmal subarachnoid hemorrhage

Nastasovic¹,

Milakovic²,

Stosic³

et al. 2017

ACTA CHIR IUG

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Introduction: Neurogenic stunned myocardium is well described after aneurysmal subarachnoid hemorrhage. Stress-induced cardiomyopathy (takotsubo cardiomyopathy) is a form of neurogenic stunned myocardium which is not common after subarachnoid hemorrhage. We describe a case report of stress-induced cardiomyopathy (takotsubo cardiomyopathy) after aneurysmal subarachnoid hemorrhage. Case report: A previously healthy postmenopausal woman suffered aneurysmal subarachnoid hemorrhage with consequent hydrocephalus. After external ventricular drainage, craniotomy and aneurysm of the posterior inferior cerebellar artery clipping, patient developed signs of acute coronary syndrome with heart failure. Transthoracic echocardiogram showed left ventricular apical ballooning and hypercontractile basal segments. On chest radiography bilateral pulmonary infiltrates were seen. Mechanical ventilation and continuous sedation were started. Five days after, patient was weaned from mechanical ventilation and extubated. On control echocardiogram, the signs of apical ballooning syndrome resolved. Conclusions: This case and review of the literature suggest stress-induced cardiomyopathy can mimic acute coronary syndrome after aneurysmal subarachnoid hemorrhage.

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“…7,8 It usually happens in postmenopausal women, but can occur at any age and in both sexes following sudden severe emotional or physical stress. It was first described in association with pheochromocytoma 9 and later in multiple conditions including subarachnoid hemorrhage, [10][11][12][13][14] seizures, [15][16][17][18] and diabetes. 19 An amazing number of case reports published on takotsubo cardiomyopathy in a vast variety of diseases and conditions suggests that the underlying mechanism is not disease-specific, but represents a stereotypical response unrelated to the nature of the primary condition.…”

Section: Discussionmentioning

confidence: 99%

Not Takotsubo: A Different Form of Stress-Induced Cardiomyopathy-A Case Series

Win

Pathak

Guglin

2011

Congestive Heart Failure

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The diagnosis of stress-induced cardiomyopathy requires wall motion abnormality, most typically apical ballooning. The authors report 3 cases of transient global left ventricular systolic dysfunction that developed over the course of severe medical illnesses. The cardiomyopathy that developed in each patient had all the features of takotsubo cardiomyopathy, including reversibility, mild troponin elevation, nonspecific electrocardiographic abnormalities, and a negative work-up for ischemia. The only difference was the absence of regional wall motion abnormalities. No patients developed sepsis or myocarditis. Stress-induced cardiomyopathy may present in different forms, including regional or global left ventricular dysfunction. Classic takotsubo syndrome may represent only part of the spectrum of this reversible condition.

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Acute Subarachnoid Hemorrhage and Cardiac Abnormalities: Takotsubo Cardiomyopathy or Neurogenic Stunned Myocardium? a case report

Abstract: Introduction: Cardiac abnormalities can be seen with subarachnoid hemorrhage. To date, there have been isolated case reports of transient left ventricular apical ballooning cardiomyopathy, also known as Takotsubo cardiomyopathy in patients suffering from subarachnoid hemorrhage.

Cited by 19 publications

References 5 publications

High-dose insulin therapy for neurogenic-stunned myocardium after stroke

High-dose insulin therapy for neurogenic-stunned myocardium after stroke

Stress-induced cardiomyopathy in aneurysmal subarachnoid hemorrhage

Not Takotsubo: A Different Form of Stress-Induced Cardiomyopathy-A Case Series

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