Noradrenaline concentrations and electrocardiographic abnormalities after aneurysmal subarachnoid haemorrhage.

Abstract

Psychiatry 1995;58:614-617)

The Role of Norepinephrine and Estradiol in the Pathogenesis of Cardiac Wall Motion Abnormality Associated With Subarachnoid Hemorrhage

“…Interestingly, neither high norepinephrine levels in the presence of high estradiol nor low estradiol levels in the presence of low norepinephrine were associated with elevated incidence of WMA. These results are in concordance with those in the literature [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] and seem to explain why WMA develops most frequently in postmenopausal women with poor-grade SAH. Although this retrospective study does not provide clues to the mechanism of possible cardiac protection by estrogen, there is much circumstantial evidence to support current results.…”

“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] WMA occurs in patients with SAH with a reported incidence of 8% to 27%. 5,7,8 It has been hypothesized that massive release of catecholamine into the systemic circulation after SAH results in the nonischemic usually reversible myocardial injury.…”

“…5,7,8 It has been hypothesized that massive release of catecholamine into the systemic circulation after SAH results in the nonischemic usually reversible myocardial injury. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] In the cardiology literature, the possible role of estrogen in the pathogenesis of WMA has recently been suggested in patients with takotsubo (stress) cardiomyopathy (TCM). 16 -18 This hypothesis is based on the clinical observation that a majority of patients with TCM are postmenopausal women, whereas only a few young women are diagnosed with TCM.…”

“…It is probable that decreased estrogen levels are causally associated with WMA in patients with SAH, because SAH-induced WMA also occurs more frequently in postmenopausal women with poor-grade SAH. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] In our institution, plasma catecholamine (epinephrine/norepinephrine) and estradiol levels are measured and transthoracic echocardiogram (TTE) is routinely performed in patients with SAH shortly after admission. This study was conducted to clarify the role of catecholamine and estrogen in the pathogenesis of SAH-induced WMA.…”

Increased Sympathetic Nervous Activity in Patients With Nontraumatic Subarachnoid Hemorrhage

“…7,8 Evidence has accumulated that suggests that these ECG abnormalities reflect underlying cardiac pathology and dysfunction, 4,5,9 possibly because of elevated catecholamines (CAT; vide supra), although other results indicate no relation between ECG changes and high levels of NE. 2,10,11 Given previous observations in patients with congestive heart failure, increased central nervous system catecholaminergic neuronal activity, which results in peripheral sympathetic activation, would be consistent with the presence of cardiac anomalies in these patients. 12,13 Although reports exist that attempt to delineate sympathetic nervous system involvement after SAH, the techniques used (which usually measure antecubital venous plasma or urinary catecholamines) lack the precision of isotope dilution methodologies.…”