Neurogenic stunned myocardium

Nguyen, Hoang P.; Zaroff, Jonathan G.

doi:10.1007/s11910-009-0071-0

Cited by 138 publications

(135 citation statements)

References 44 publications

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“…Though neurogenic stunning myocardium and Takotsubo cardiomyopathy share common features such as reversible LV dysfunction, in the present case, the patient presented with pulmonary edema and global hypokinesia, favoring the diagnosis of neurogenic stunning myocardium [5]. Based on previous reports in the literature, the most characteristic feature of neurogenic stunning myocardium is its complete reversibility and the restoration of normal myocardial function if the underlying acute neurological condition improves [6,7]. cardiomyopathy, neurogenic stunning myocardium was considered as a primary cause of the transient LV dysfunction in this patient because the patient developed 3 discrete episodes of tonic-clonic seizures.…”

Section: Discussionmentioning

confidence: 57%

“…Several episodes of TdP requiring defibrillation in this patient can also be the direct cause for post resuscitation stunning myocardium which may have been the contributing factor for transient global LV dysfunction. Takotsubo cardiomyopathy, neurogenic stunning myocardium and post resuscitation stunning myocardium share common clinical features such as reversible LV dysfunction and good prognosis [6][7][8]. Moreover, they also share common pathophysiology, exaggerated sympathetic stimulation and elevated plasma catecholamines that may result in direct myocyte injury via an increase in intracellular calcium and oxygen-free radicals, diffuse coronary microvascular dysfunction, multivessel epicardial spasm, transient dynamic LV outflow tract obstruction, or direct injury to myocytes [9,10].…”

Section: Discussionmentioning

confidence: 99%

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Differential Diagnosis of Transient Left Ventricular Dysfunction in a Critically Ill Patient

Jayaraj¹,

Ganesan²

2018

J Clin Exp Cardiolog

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There is evidence illustrating that the etiologies of non-ischemic LV (left ventricular) dysfunction such as Takotsubo cardiomyopathy, neurogenic stunning myocardium and post resuscitation stunning myocardium have a favorable clinical outcome. Good prognosis in non-ischemic LV dysfunction provides us courage to treat the condition expecting good. We describe herein the unique case of a 33-year-old woman who was started on combination chemotherapy of oxaliplatin and 5-flurouracil for colon adenocarcinoma. The patient's baseline QTc was 460 ms. Twenty-four hours following initiation of chemotherapy, the patient developed 3 discrete episodes of tonicclonic seizures. Electrocardiogram assessment demonstrated a prolonged QTc interval (623 ms) with several episodes of TdP. Two episodes required defibrillation to revert to sinus rhythm. Post resuscitation echocardiogram showed severe global LV dysfunction with ejection fraction of 33%. The patient subsequently required mechanical ventilation due to severe LV dysfunction with pulmonary edema. Possible etiologies for LV dysfunction in the present case include global Takotsubo cardiomyopathy, neurogenic stunning myocardium or post resuscitation stunning myocardium. Repeat echocardiogram 48 h later showed the ejection fraction of 60%. Although myocardial dysfunction associated with Takotsubo cardiomyopathy, neurogenic stunning myocardium and post resuscitation stunning myocardium have been previously described independently, the present case is unique in that, to our knowledge, torsade de pointes presented with transient left ventricular dysfunction following several episodes of seizures and post resuscitation stunning myocardium that were stabilized in one patient following oxaliplatin and 5-fluorouracil infusion has not been reported. Case ReportA 33-year-old female patient who underwent hemicolectomy for colon adenocarcinoma was admitted for chemotherapy. Her past medical history was unremarkable and notably, not significant for cardiovascular, respiratory or neurological disorders. She did not have intracranial metastasis. The patient was not on any medications that could affect the QT interval. Baseline blood investigations including electrolytes and renal parameters were within normal limits. The physical examination was unremarkable. Baseline electrocardiogram demonstrated normal sinus rhythm, normal PR interval and the Bazett-corrected QT interval was 460 ms. Echocardiogram showed normal size cardiac chambers, no regional wall motion abnormality and good LV systolic function, with ejection fraction of 67%.Chemotherapy regimen was modified Folfox consisting of oxaliplatin 85 mg/m 2 intravenous on Day 1, 5-FU 400 mg/m 2 intravenous bolus on Day 1, followed by continuous infusion 1500 mg/m 2 for 22 h on Day 1 and 2. Leucovorin (folinic acid) 75 mg/m 2 was given as continuous infusion on Day 1 and 2.Twenty-four hours after initiation of chemotherapy, the patient developed a seizure that was initially treated with intravenous diphenylhydantoin in the ward. Withi...

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Section: Discussionmentioning

confidence: 57%

Section: Discussionmentioning

confidence: 99%

Differential Diagnosis of Transient Left Ventricular Dysfunction in a Critically Ill Patient

Jayaraj¹,

Ganesan²

2018

J Clin Exp Cardiolog

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“…The symptoms of acute left ventricular failure usually occur within the days following the development of CNS pathology [3]. The most characteristic feature of NSM is its complete reversibility and the restoration of normal myocardial function if the underlying acute neurological condition improves [2,3,16].…”

Section: Epidemiology and Clinical Picturementioning

confidence: 99%

“…The most characteristic feature of NSM is its complete reversibility and the restoration of normal myocardial function if the underlying acute neurological condition improves [2,3,16]. In the majority of cases, the return of normal left ventricular function is seen within 5−14 days, sometimes several weeks [2,15].…”

Section: Epidemiology and Clinical Picturementioning

confidence: 99%

“…One of the rare and poorly known pathologies is neurogenic stunned myocardium (NSM), which can develop in any acute CNS pathology. Awareness of its existence is essential as, although NSM is associated with an increased risk of severe, life-threatening complications, death and persistent neurologic disorders, it is also a fully reversible pathology provided the underlying disease has been brought under control [3].…”

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confidence: 99%

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

Mierzewska-Schmidt

Gawecka²

2015

Anaesthesiol Intensive Ther

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Neurogenic stunned myocardium (NSM) is defined as myocardial injury and dysfunction of a sudden onset, occurring after various types of acute brain injury as a result of an imbalance in the autonomic nervous system. The typical spectrum of clinically observed abnormalities includes acute left ventricular failure, not uncommonly progressing to cardiogenic shock with hypotension that requires inotropic agents, pulmonary oedema and various arrhythmias. Commonly-seen electrocardiographic changes include: prolonged QT interval, ST segment changes, T-wave inversion, a new Q-wave or U-wave. Echocardiography shows both an impaired both systolic and diastolic function of the left ventricle. Biochemical markers of NSM comprise metabolic acidosis and increased cardiac enzymes and markers: creatine kinase (CK), and CK-MB, troponin I and B-type natriuretic peptide. The main cause of NSM is myocardial injury induced by local catecholamine release from nerve endings within the myocardium. Recently, a theory has been proposed to classify NSM as one of the stress-related cardiomyopathies, together with Takotsubo cardiomyopathy, acute left ventricular failure in the critically ill, cardiomyopathy associated with pheochromacytoma and exogenous catecholamine administration. The occurrence of NSM increases the risk of life-threatening complications, death, and worsens neurologic outcome. As far as we know, treatment should generally focus on the underlying neurologic process in order to maximize neurologic recovery. Improvement in neurologic pathology leads to rapid improvement in cardiac function and its full recovery, as NSM is a fully reversible condition if the patient survives. Awareness of the existence of NSM and a deeper knowledge of its etiopathology may reduce diagnostic errors, optimise its treatment.

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Effects of Stroke on the Autonomic Nervous System

Dorrance

Fink

2015

Comprehensive Physiology

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Stroke is the fourth leading cause of death in the United States and the second most common cause of death worldwide; stroke is also the leading cause of long-term disability worldwide. It is clear that the consequences of cerebral ischemia reach beyond the brain into the periphery, and a significant number of stroke related deaths are the result of conditions that develop poststroke in the periphery. The two leading causes of non-neurogenic death poststroke are cardiac abnormalities and infections. Changes in autonomic nervous system function that favor increased sympathetic nervous system activity and reduced parasympathetic nervous system activity appear to be causative factors in both conditions. Here, we review the evidence that sympathetic nervous system activity increases and parasympathetic nervous system activity declines poststroke. We discuss effects of autonomic dysfunction on cardiac arrhythmias and heart rate variability. Finally, we discuss the evidence supporting a role for autonomic dysfunction in the increased incidence of infection poststroke. Although the death rate from stroke is declining in the United States, the incidence of stroke is not. With more patients surviving the initial ischemic event it is important that we broaden our understanding of the chronic effects of stroke on the human condition.

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Neurogenic stunned myocardium

Cited by 138 publications

References 44 publications

Differential Diagnosis of Transient Left Ventricular Dysfunction in a Critically Ill Patient

Differential Diagnosis of Transient Left Ventricular Dysfunction in a Critically Ill Patient

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

Effects of Stroke on the Autonomic Nervous System

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