Takotsubo cardiomyopathy in aneurysmal subarachnoid hemorrhage: Institutional experience and literature review

Talahma, Murad; Alkhachroum, Ayham; Alyahya, Mossaed; Manjila, Sunil; Xiong, Wei

doi:10.1016/j.clineuro.2015.12.005

Cited by 37 publications

(46 citation statements)

References 39 publications

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“…It is more common in patients with poor clinical grade (World Federation of Neurolosurgical Societies (WFNS) grade 4–5) SAH and when present may increase the mortality rate by up to 7% 14. The pathology of this entity is not well understood but is believed to be related to catecholamine surges.…”

Section: Discussionmentioning

confidence: 99%

Complete heart block as the presenting feature in subarachnoid haemorrhage

Pepper¹,

Fenton

Brydon

2017

BMJ Case Reports

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Cardiac manifestations of subarachnoid haemorrhage (SAH) are well-documented phenomena that can complicate the treatment of this devastating condition. Here, we present a case of SAH presenting as complete heart block on initial assessment, an extremely rare event.A 53-year-old woman presented with a witnessed fall, sustaining a mild head injury. She denied any symptoms of SAH. Initial ECG revealed complete heart block, for which the patient was accepted under the cardiology team. For completion, a CT head scan was requested, this demonstrated significant SAH blood load in an aneurysmal rather than traumatic pattern. CT angiogram and subsequent digital subtraction angiography confirmed a posterior communicating artery aneurysm as the cause of the SAH. This case highlights the importance of considering neurological diagnoses in patients with collapse even with concomitant cardiac abnormalities, as the two are often inextricably linked.

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Section: Discussionmentioning

confidence: 99%

Complete heart block as the presenting feature in subarachnoid haemorrhage

Pepper¹,

Fenton

Brydon

2017

BMJ Case Reports

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“…The relationship of these ECG abnormalities and cardiac rhythm disturbances with NSC was found out only later on [6]. The currently reported prevalence of NSC among aSAH patients range from 2.2% to 17% [12,[16][17][18][19][20]. Brain injury (autonomous nervous system damage in supramedullar or medullar regions) during an acute neurological event is the main factor for the development of subsequent cardiac manifestations.…”

Section: Subarachnoid Haemorrhage and Neurogenic Stress Cardiomyopathymentioning

confidence: 99%

Neurogenic stress cardiomyopathy following aneurysmal subarachnoid haemorrhage: a literature review

Piliponis

Neverauskaite-Piliponiene

Monika

et al. 2019

Seminars in Cardiovascular Medicine

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Neurogenic stress cardiomyopathy (NSC) is defined as transient cardiac dysfunction occurring after primary brain injury, such as aneurysmal subarachnoid haemorrhage, and characterised by left ventricular systolic dysfunction with reduced ejection fraction and abnormalities of regional wall motion. It may also be suspected if elevated levels of cardiac biomarkers and ECG abnormalities are present. It is a reversible condition with favourable long-term prognosis if diagnosed and treated timely, however, NSC is associated with higher rates of early mortality and complications, including pulmonary oedema, cardiogenic shock, delayed cerebral ischaemia. Early diagnosis of the NSC is important in order to prevent these complications and reduce mortality. Management of the NSC is complicated and a multidisciplinary approach is usually required. Seminars in Cardiovascular Medicine 2019; 25:44-52

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“…A massive release of catecholamines into the systemic circulation after aneurysmal rupture has been considered responsible for SAH-induced TCM. In view of the literature reviews (Table 1), the incidence of TCM in SAH patients ranges from 0.8 to 17% [1,2,7,[10][11][12], which makes it a relatively common postoperative complication. However, the management of TCM becomes cumbersome in the setting of volumetric and hemodynamic therapy for DCI.…”

Section: Absence Of Other Precipitants Such As Pheochromocytoma and Mmentioning

confidence: 99%

“…The underlying mechanism of TCM is not fully understood. Several theories have been proposed to explain its pathophysiology including excessive sympathetic stimulation, microvascular dysfunction, coronary artery vasospasm, and abnormal myocardial tissue metabolism [1]. An excessive release of catecholamines (catecholamine surge or sympathetic storming) immediately after insult associated with aneurysm rupture seems to have a pivotal role in the development of TCM.…”

Section: Pathophysiology Of Post-sah Tcmmentioning

confidence: 99%

“…Postoperative management of aneurysmal subarachnoid hemorrhage (SAH) is sometimes complicated by systemic cardiopulmonary complications to affect a significant impact on the morbidity and mortality of the patients [1,2]. The neuro-cardiac injury of SAH is of particular importance because of their impact on the ability to manage blood pressure and volume status, especially in the setting of cerebral vasospasm or delayed cerebral ischemia (DCI).…”

Section: Introductionmentioning

confidence: 99%

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Takotsubo Cardiomyopathy as a Neurocardiogenic Injury after Subarachnoid Hemorrhage: Hemodynamics and Fluid Management

Mutoh¹,

Mutoh²,

Taki³

et al. 2017

Cardiomyopathies - Types and Treatments

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Takotsubo cardiomyopathy (TCM) is a life-threatening systemic disorder that may occur early after aneurysmal subarachnoid hemorrhage (SAH), but precise hemodynamics and fluid management remain unclear. Although TCM is often regarded as a reversible or self-limited phenomenon, it contributes significantly to morbidity and mortality of SAH patients, especially when it is complicated with other neurogenic injuries such as severe left ventricular dysfunction, pulmonary edema, and pneumonia. The purpose of this chapter is to introduce the current practice in intensive hemodynamic monitoring and goal-directed fluid management of post-SAH TCM using advanced hemodynamic devices based on our institutional protocol and the relevant literature and to evaluate their effects on clinical outcomes.

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Takotsubo cardiomyopathy in aneurysmal subarachnoid hemorrhage: Institutional experience and literature review

Cited by 37 publications

References 39 publications

Complete heart block as the presenting feature in subarachnoid haemorrhage

Complete heart block as the presenting feature in subarachnoid haemorrhage

Neurogenic stress cardiomyopathy following aneurysmal subarachnoid haemorrhage: a literature review

Takotsubo Cardiomyopathy as a Neurocardiogenic Injury after Subarachnoid Hemorrhage: Hemodynamics and Fluid Management

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