Stunned Myocardium following Ischemic Stroke

Dias, V. Costa; Cabral, Sofia; Meireles, Ana Célia Maia; Gomes, Catarina; Antunes, Nuno; Vieira, Miguel Silva; Caiado, Luísa; Torres, Severo

doi:10.1159/000205963

Cited by 14 publications

(7 citation statements)

References 12 publications

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“…As is the case with Takotsubo cardiomyopathy in general, when present, there is a female preponderance following stroke; however, cases have also been reported in males (79) including those whose strokes involved the left insula (54) (Fig. 9).…”

Section: Myocytolysis: Cardiac Contractile Dysfunction and Takotsubo mentioning

confidence: 92%

“…9). Although contractility impairment may last only a few days, in one study where follow-up was reported, it persisted for several months after infarction (79). The clinical significance lies in the finding that Takotsubo cardiomyopathy is associated with ventricular arrhythmias and SCD (6,307).…”

Section: Myocytolysis: Cardiac Contractile Dysfunction and Takotsubo mentioning

confidence: 99%

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The Insular Cortex and the Regulation of Cardiac Function

Oppenheimer

Cechetto

2016

Comprehensive Physiology

169

128

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Cortical representation of the heart challenges the orthodox view that cardiac regulation is confined to stereotyped, preprogrammed and rigid responses to exteroceptive or interoceptive environmental stimuli. The insula has been the region most studied in this regard; the results of clinical, experimental, and functional radiological studies show a complex interweave of activity with patterns dynamically varying regarding lateralization and antero-posterior distribution of responsive insular regions. Either acting alone or together with other cortical areas including the anterior cingulate, medial prefrontal, and orbito-frontal cortices as part of a concerted network, the insula can imbue perceptions with autonomic color providing emotional salience, and aiding in learning and behavioral decision choice. In these functions, cardiovascular input and the right anterior insula appear to play an important, if not pivotal role. At a more basic level, the insula gauges cardiovascular responses to exteroceptive and interoceptive stimuli, taking into account memory, cognitive, and reflexive constructs thereby ensuring appropriate survival responses and maintaining emotional and physiological homeostasis. When acquired derangements to the insula occur after stroke, during a seizure or from abnormal central processing of interoceptive or exteroceptive environmental cues as in psychiatric disorders, serious consequences can arise including cardiac electrophysiological, structural and contractile dysfunction and sudden cardiac death.

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Section: Myocytolysis: Cardiac Contractile Dysfunction and Takotsubo mentioning

confidence: 92%

Section: Myocytolysis: Cardiac Contractile Dysfunction and Takotsubo mentioning

confidence: 99%

The Insular Cortex and the Regulation of Cardiac Function

Oppenheimer

Cechetto

2016

Comprehensive Physiology

169

128

View full text Add to dashboard Cite

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“…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.…”

Section: Ischemic Strokementioning

confidence: 99%

CNS disease triggering Takotsubo stress cardiomyopathy

Finsterer

Wahbi

2014

International Journal of Cardiology

120

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“…This complication has been exceptionally reported after ischaemic or haemorrhagic stroke, but is probably underestimated 3–6. Indeed, in the series published by Yoshimura et al 7, the incidence in patients with ischaemic stroke was 1.2%.…”

Section: Discussionmentioning

confidence: 92%

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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Stunned Myocardium following Ischemic Stroke

Cited by 14 publications

References 12 publications

The Insular Cortex and the Regulation of Cardiac Function

The Insular Cortex and the Regulation of Cardiac Function

CNS disease triggering Takotsubo stress cardiomyopathy

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

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