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

Abstract

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

CNS disease triggering Takotsubo stress cardiomyopathy

“…Searching the appropriate literature according to the criteria mentioned above revealed that TTS has been reported in association with ischemic stroke in more than 20 cases so far [100][101][102][103][104][105][106][107][108][109][110][111][112][113]. No systematic studies on the prevalence of TTS in ischemic stroke have been carried out.…”

Management of Severe Beta-Blockers Toxicity with High Dose Insulin Euglycemic Therapy: A Case Report

“…Several studies showed improvements of left ventricular function in patients with myocardial infarctions following high dose insulin and glucose infusions, which were similar to a low dose dobutamine infusion [2,9]. Furthermore, Insulin increases myocardial glucose uptake thus improving the fuel sources for the myocardium, which switch from its normal free fatty acids to glucose for energy utilizations during stress conditions.…”

Ogłuszone serce neurogenne — czy uwzględniamy to rozpoznanie u chorych z ostrym uszkodzeniem ośrodkowego układu nerwowego i niewydolnością serca?

“…NSM has also been observed in individuals with ischaemic stroke [4], craniocerebral trauma [5,6], encephalitis [7], myelitis [8], Guillain-Barre syndrome [9,10], following neurosurgical procedures [11], as well as in those with acute hydrocephalus [12,13], status epilepticus [14] and other acute CNS injuries. Although any acute pathology of CNS is likely to induce NSM syndrome, one's individual predisposition seems crucial.…”