Neurogenic cardiac injury

Abstract

Cardiac injury may occur following many types of brain injury, although the most widely investigated form of neurocardiogenic injury is subarachnoid hemorrhage (SAH). Echocardiography may help prognosticate and aid in the treatment of SAH if left ventricular (LV) dysfunction is suspected or if troponin levels are elevated. Cardiac catheterization, however, is not routinely recommended in SAH patients with LV dysfunction and elevated troponin. The priority should be treatment of the underlying neurological condition, even in the setting of LV dysfunction. Cardiac injury that occurs following an SAH appears to be reversible. For patients that develop brain death cardiac evaluation under optimal conditions may help increase the donor pool.

Relation of Elevation in Cardiac Troponin I to Clinical Severity, Cardiac Dysfunction, and Pulmonary Congestion in Patients With Subarachnoid Hemorrhage

“…10 In addition, increases in cTnI were associated with increased mortality in critically ill patients, 11 and even slight increases in cTnI (≥0.04 ng/ml) were associated with increased mortality rates in patients with advanced chronic heart failure. 12 Although the cardiac injury associated with SAH was usually temporary and normalized over time, the degree of cardiac dysfunction was highly variable, 2,7,13–16 and the clinical significance of acutely increased cTnI after SAH, especially when mildly positive, was not well understood. Accordingly, our objective was to test the hypothesis that increases in cTnI in patients with aneurysmal SAH were related to severity of the clinical neurologic condition, cardiac systolic and diastolic function, and occurrence of acute pulmonary congestion.…”

Intensivists and organ donor management

“…Increasing the cardiac yield from donors will require an understanding of the reversibility of regional wall motion abnormalities secondary to the antecedent neurotrauma and brain death event, and optimizing cardiac function to facilitate reversibility and the time required for reversibility to manifest. Recent data suggest that there is minimal correlation between the area of echocardiographic abnormality and histopathology, and that a substantial number of patients with severe brain injury or brain-dead donors will resolve their focal/regional wall motion abnormalities [18,19]. Aggressive attempts at hemodynamic stabilization using pulmonary artery catheterization or serial echocardiography have resulted in dramatic improvements in reversibility of cardiac function and cardiac yield.…”

Brain Death and Donor Management

“…Standardized guidelines and algorithms focusing on hemodynamic stabilization have proved beneficial in this setting. 3,86,96,98 In a study of brain-dead patients, echocardiographic evidence of systolic dysfunction was present in 42%, which was not predicted by electrocardiogram or clinical history. A trial employing a standardized donor management protocol increased the number of organs procured by 10.3% per 100 donors and the organs transplanted by 11.3% per 100 donors compared with conventional management.…”

“…3,36,98 Similarly, neuroendocrine dysfunction after traumatic brain injury has been described and is attributed to direct injury to the hypothalamic-pituitary axis, effects of catecholamines and cytokines, or systemic infection and inflammation. In addition to the systemic effects of polytrauma, isolated brain injury before brain death is reported to affect the cardiac and neuroendocrine systems.…”