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Deenen S, Ramnarain D, Pouwels S. Subarachnoidal hemorrhage related cardiomyopathy: an overview of Tako-Tsubo cardiomyopathy and related cardiac syndromes. Expert Rev Cardiovasc Ther 2022; 20:733-745. [PMID: 36124824 DOI: 10.1080/14779072.2022.2125871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
INTRODUCTION Subarachnoid hemorrhage (SAH) is caused by a ruptured intracranial aneurysm leading to acute extravasation of blood into the subarachnoid space. SAH has an incidence of 6.3 per 100,000 persons per year in Europe and accounts for 5% of all strokes. SAH occurs at a relatively young age and has poor clinical outcomes and high mortality rates. Cardiac syndromes are regularly seen in patients with acute neurologic disease including SAH. These cardiac complications of SAH are associated with increased morbidity and mortality and present in a large variety and severity. AREAS COVERED The main goal of this review is to describe the SAH-related cardiac syndromes. Secondly, we will provide an overview of the underlying pathophysiology regarding the development of cardiac syndromes. Thirdly, we will describe the impact of cardiac syndromes on patient outcome. EXPERT OPINION Of all neurology patients, SAH patients have the highest risk of developing takotsubo syndrome (TTS), occurring in about 0.8-30% of patients. Both TTS and neurogenic stunned myocardium have many similarities on echocardiographic evaluation. In European Cardiology consensus, SAH is recognized as a primary cause of TTS.
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Affiliation(s)
- Susan Deenen
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - Dharmanand Ramnarain
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands.,Department of Intensive Care Medicine, Saxenburgh Medical Center, Hardenberg, The Netherlands
| | - Sjaak Pouwels
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands.,Department of General, Abdominal and Minimally Invasive Surgery, Helios Klinikum, Krefeld, Germany
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Munakata M, Kanazawa H, Kimura K, Arai T, Sukegawa H, Fukuda K. Assessment of cardiac function in rat endovascular perforation model of subarachnoid hemorrhage; A model of subarachnoid hemorrhage-induced cardiac dysfunction. Front Synaptic Neurosci 2022; 14:919998. [PMID: 36017128 PMCID: PMC9396209 DOI: 10.3389/fnsyn.2022.919998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 07/20/2022] [Indexed: 12/02/2022] Open
Abstract
Although the association between cardiac dysfunction and subarachnoid hemorrhage (SAH) has been recognized, its precise underlying mechanism remains unknown. Furthermore, no suitable animal models are available to study this association. Here, we established an appropriate animal model of SAH-induced cardiac dysfunction and elucidated its mechanism. In this rat model, contrast-enhanced computed tomography of the brain confirmed successful induction of SAH. Electrocardiography detected abnormalities in 55% of the experimental animals, while echocardiography indicated cardiac dysfunction in 30% of them. Further evaluation of left ventriculography confirmed cardiac dysfunction, which was transient and recovered over time. Additionally, in this SAH model, the expression of the acute phase reaction protein, proto-oncogene c-Fos increased in the paraventricular hypothalamic nucleus (PVN), the sympathetic nerve center of the brain. Polymerase chain reaction analysis revealed that the SAH model with cardiac dysfunction had higher levels of the macrophage-associated chemokine (C-X-C motif) ligand 1 (CXCL-1) and chemokine (C-C motif) ligand 2 (CCL-2) than the SAH model without cardiac dysfunction. Our results suggested that SAH caused inflammation and macrophage activation in the PVN, leading to sympathetic hyperexcitability that might cause cardiac dysfunction directly and indirectly. This animal model may represent a powerful tool to investigate the mechanisms of the brain-heart pathway.
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Affiliation(s)
| | - Hideaki Kanazawa
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
- Hideaki Kanazawa,
| | | | - Takahide Arai
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Hiroaki Sukegawa
- Division of Cardiology, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
| | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
- *Correspondence: Keiichi Fukuda,
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Mommers L, Slagt C. Introducing the C’s in CPR. Resuscitation 2022; 173:101-102. [DOI: 10.1016/j.resuscitation.2022.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 11/27/2022]
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Abstract
Introduction: Cardiovascular complications in patients with subarachnoid hemorrhage are considered to be a neurally mediated process rather than a manifestation of coronary artery disease. Aim: The aim of study is to show the incidence and type cardiac complications after traumatic and spontaneous SAH. Patients and methods: The study had prospective character in which included 104 patients, with diagnosed subarachnoid hemorrhage (SAH), in the period from 2014 to 2017. Two groups of patients were formed. Group I: patients with SAH caused by the rupture of a brain aneurysm. Group II: patients with SAH after traumatic brain injury. Results: Electrocardiogram (ECG) abnormalities was predominant after traumatic brain injury 74 %, with statistically significant difference atrial fibrillation 42.5 % (p = 0.043) and sinus bradycardia 31.4 % (p = 0.05). Hypertension are predominant in patients with spontaneous SAH with statistically significant difference (15 (27.7%) vs 36 (72%) p=0.034) and hypotension in group II (10 (18.5%) vs 2 (4%) p = 0.021 ) with traumatic SAH patients. The time in Intensive Care Unit (ICU) for traumatic SAH group was 6.1 ± 5.2 days and 3.9 ± 1.16 for spontaneous SAH group with statistical significance (p = 0.046). Respiratory support time was longer in traumatic SAH group (39.4 ± 23.44 vs. 15.66 ± 22.78) with p = 0.043. Conclusion: Cardiac dysfunction in patients with subarachnoid hemorrhage are considered to be a neurally mediated process rather than a manifestation of coronary artery disease. Early treatment of cerebral injury could be reduce incidence of cardiac complications after traumatic brain injury. Cardiac dysfunction in patients with SAH is still very high, despite substantial qualitative progress in their treatment.
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Affiliation(s)
- Selma Sijercic
- Clinic for Anesthesiology and Reanimatology, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Alisa Krdzalic
- Clinic for Cardiovascular Surgery, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Harun Avdagic
- Clinic for Cardiovascular Surgery, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Goran Krdzalic
- Clinic for Surgery, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
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Usefulness of early plasma S-100B protein and Neuron-Specific Enolase measurements to identify cerebrovascular etiology of out-of-hospital cardiac arrest. Resuscitation 2018; 130:61-66. [DOI: 10.1016/j.resuscitation.2018.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 06/21/2018] [Accepted: 07/04/2018] [Indexed: 11/21/2022]
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Urdaneta AE, Fink KR, Krishnamoorthy V, Rowhani-Rahbar A, Vavilala MS. Radiographic and Clinical Predictors of Cardiac Dysfunction Following Isolated Traumatic Brain Injury. J Intensive Care Med 2016; 32:151-157. [DOI: 10.1177/0885066615616907] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Introduction: Although cardiac dysfunction after traumatic brain injury (TBI) has been described, there is little data regarding the association of radiographic severity and particular lesions of TBI with the development of cardiac dysfunction. We hypothesize that the Rotterdam or Marshall scores and particular TBI lesions are associated with the development of cardiac dysfunction after isolated TBI. Methods: We performed a retrospective cohort study. Adult patients with isolated TBI who underwent echocardiography between 2003 and 2010 were included. A board-certified neuroradiologist assessed the first computed tomography head, assigning the Rotterdam and Marshall scores and the type of TBI. Cardiac dysfunction was defined as either systolic or all cause based on the first echocardiogram after TBI. Demographic, radiological, and clinical variables were used in our analysis. Results: A total of 139 patients were identified, with 20 having isolated systolic dysfunction. The Marshall and Rotterdam scores were not associated with the development of cardiac dysfunction. Only head Abbreviated Injury Scale was found to be an independent predictor of systolic cardiac dysfunction (relative risk: 2.70, 95% confidence interval: 1.19-6.13; P = .02). Conclusions: No specific radiographic variable was found to be an independent predictor of cardiac dysfunction. Further study into clinical or radiological features that would warrant an echocardiogram is warranted, as it may direct patient management.
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Affiliation(s)
- Alfredo E. Urdaneta
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA, USA
| | - Kathleen R. Fink
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Vijay Krishnamoorthy
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA, USA
| | | | - Monica S. Vavilala
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA, USA
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Krishnamoorthy V, Mackensen GB, Gibbons EF, Vavilala MS. Cardiac Dysfunction After Neurologic Injury: What Do We Know and Where Are We Going? Chest 2015; 149:1325-31. [PMID: 26836901 DOI: 10.1016/j.chest.2015.12.014] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 12/11/2015] [Accepted: 12/13/2015] [Indexed: 01/06/2023] Open
Abstract
Recent literature has implicated severe neurologic injuries, such as aneurysmal subarachnoid hemorrhage, as a cause of cardiac dysfunction, impaired hemodynamic function, and poor outcomes. Mechanistic links between the brain and the heart have been explored in detail over the past several decades, and catecholamine excess, neuroendocrine dysfunction, and unchecked inflammation all likely contribute to the pathophysiologic process. Although cardiac dysfunction has also been described in other disease paradigms, including septic shock and thermal injury, there is likely a common underlying pathophysiology. In this review, we will examine the pathophysiology of cardiac dysfunction after neurologic injury, discuss the evidence surrounding cardiac dysfunction after different neurologic injuries, and suggest future research goals to gain knowledge and improve outcomes in this patient population.
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Affiliation(s)
- Vijay Krishnamoorthy
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA; Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA.
| | - G Burkhard Mackensen
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA
| | - Edward F Gibbons
- Department of Medicine, University of Washington, Seattle, WA; Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA
| | - Monica S Vavilala
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA; Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA
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Pinnamaneni S, Dutta T, Melcer J, Aronow WS. Neurogenic stress cardiomyopathy associated with subarachnoid hemorrhage. Future Cardiol 2015; 11:77-87. [PMID: 25606704 DOI: 10.2217/fca.14.73] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Cardiac manifestations are recognized complications of subarachnoid hemorrhage. Neurogenic stress cardiomyopathy is one complication that is seen in acute subarachnoid hemorrhage. It can present as transient diffuse left ventricular dysfunction or as transient regional wall motion abnormalities. It occurs more frequently with neurologically severe-grade subarachnoid hemorrhage and is associated with increased morbidity and poor clinical outcomes. Managing this subset of patients is challenging. Early identification followed by a multidisciplinary team approach can potentially improve outcomes.
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Abstract
OBJECTIVES Cardiac dysfunction has been reported to occur in as much as 42% of adults with brain death, and may limit cardiac donation after brain death. Knowledge of the prevalence and natural course of cardiac dysfunction after brain death may help to improve screening and transplant practices but adequately sized studies in pediatric brain death are lacking. The aims of our study are to describe the prevalence and course of cardiac dysfunction after pediatric brain death. DESIGN Cross-sectional study. SETTING/SUBJECTS We examined an organ procurement organization database (Life Center Northwest) of potential pediatric cardiac donors diagnosed with brain death between January 2011 and November 2013. INTERVENTION Transthoracic echocardiograms were reviewed for cardiac dysfunction (defined as ejection fraction <50% or the presence of regional wall motion abnormalities). Descriptive statistics were used to analyze clinical characteristics and describe longitudinal echocardiogram findings in a subgroup of patients. We examined for heterogeneity between cardiac dysfunction with respect to cause of brain death. MEASUREMENT AND MAIN RESULTS We identified 60 potential pediatric cardiac donors (age ≤ 18 yr) with at least one transthoracic echocardiogram following brain death. Cardiac dysfunction was present in 23 patients (38%) with brain death. Mean ejection fraction (37.6% vs 62.2%) and proportion of procured hearts (56.5% vs 83.8%) differed significantly between the groups with and without cardiac dysfunction, respectively. Of the 11 subjects with serial transthoracic echocardiogram data, the majority of patients with cardiac dysfunction (73%) improved over time, leading to organ procurement. No heterogeneity between cardiac dysfunction and particular causes of brain death was observed. CONCLUSION The frequency of cardiac dysfunction in children with brain death is high. Serial transthoracic echocardiograms in patients with cardiac dysfunction showed improvement of cardiac function in most patients, suggesting that initial decisions to procure should not solely depend on the initial transthoracic echocardiogram examination results.
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Borbely XI, Krishnamoorthy V, Modi S, Rowhani-Rahbar A, Gibbons E, Souter MJ, Vavilala MS. Temporal Changes in Left Ventricular Systolic Function and Use of Echocardiography in Adult Heart Donors. Neurocrit Care 2015; 23:66-71. [DOI: 10.1007/s12028-014-0101-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Kundra S, Mahendru V, Gupta V, Choudhary AK. Principles of neuroanesthesia in aneurysmal subarachnoid hemorrhage. J Anaesthesiol Clin Pharmacol 2014; 30:328-37. [PMID: 25190938 PMCID: PMC4152670 DOI: 10.4103/0970-9185.137261] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Aneurysmal subarachnoid hemorrhage is associated with high mortality. Understanding of the underlying pathophysiology is important as early intervention can improve outcome. Increasing age, altered sensorium and poor Hunt and Hess grade are independent predictors of adverse outcome. Early operative interventions imposes an onus on anesthesiologists to provide brain relaxation. Coiling and clipping are the two treatment options with increasing trends toward coiling. Intraoperatively, tight control of blood pressure and adequate brain relaxation is desirable, so that accidental aneurysm rupture can be averted. Patients with poor grades tolerate higher blood pressures, but are prone to ischemia whereas patients with lower grades tolerate lower blood pressure, but are prone to aneurysm rupture if blood pressure increases. Patients with Hunt and Hess Grade I or II with uneventful intraoperative course are extubated in operation theater, whereas, higher grades are kept electively ventilated. Postoperative management includes attention toward fluid status and early management of vasospasm.
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Affiliation(s)
- Sandeep Kundra
- Department of Anesthesia, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Vidhi Mahendru
- Department of Anesthesia, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Vishnu Gupta
- Department of Neurosurgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
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Yamashina Y, Yagi T, Ishida A, Mibiki Y, Sato H, Nakagawa T, Sato E, Komatsu J. Differentiating between comatose patients resuscitated from acute coronary syndrome-associated and subarachnoid hemorrhage-associated out-of-hospital cardiac arrest. J Cardiol 2014; 65:508-13. [PMID: 25192593 DOI: 10.1016/j.jjcc.2014.07.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 07/07/2014] [Accepted: 07/11/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Upon initial evaluation in the emergency department (ED), it is often difficult to differentiate between comatose patients resuscitated following acute coronary syndrome (ACS)-associated and subarachnoid hemorrhage (SAH)-associated out-of-hospital cardiac arrest (OHCA). We assessed the clinical differences between resuscitated comatose ACS-OHCA and SAH-OHCA patients during initial evaluation in the ED. METHODS Data of 1259 consecutive OHCA patients were analyzed retrospectively. Of these, 23 resuscitated comatose ACS-OHCA patients and 20 resuscitated comatose SAH-OHCA patients were included in the final analysis. Clinical data obtained during initial evaluation in the ED were compared between groups. RESULTS Pulseless electrical activity (PEA) or asystole as the initial cardiac rhythm, female gender, and preserved left ventricular ejection fraction (≥50%) on the echocardiogram were significantly more common in the SAH-OHCA group (p<0.05 each). Although ST-T abnormalities suggesting myocardial damage (ST elevation and/or ST depression) were noted in most patients in both groups via 12-lead electrocardiogram (95%, ACS-OHCA group; 85%, SAH-OHCA group, p=0.50), reciprocal ST depression was significantly more often absent in the SAH-OHCA group (p=0.025). Initial PEA/asystole and presence of 1 other factor was sufficient to differentiate SAH-OHCA patients from ACS-OHCA patients (100% sensitivity, 91% specificity, 95% accuracy). CONCLUSIONS Initial ED evaluation is sufficient to differentiate between comatose ACS-OHCA and SAH-OHCA patients prior to further diagnostic work-up (e.g. emergent coronary angiography and head computed tomography).
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Affiliation(s)
| | - Tetsuo Yagi
- Division of Cardiology, Sendai City Hospital, Sendai, Japan.
| | - Akihiko Ishida
- Division of Cardiology, Sendai City Hospital, Sendai, Japan
| | | | - Hirokazu Sato
- Division of Cardiology, Sendai City Hospital, Sendai, Japan
| | | | - Eiji Sato
- Division of Cardiology, Sendai City Hospital, Sendai, Japan
| | - Juri Komatsu
- Division of Cardiology, Sendai City Hospital, Sendai, Japan
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Najafipour H, Siahposht Khachaki A, Khaksari M, Shahouzehi B, Joukar S, Poursalehi HR. Traumatic brain injury has not prominent effects on cardiopulmonary indices of rat after 24 hours: hemodynamic, histopathology, and biochemical evidence. IRANIAN BIOMEDICAL JOURNAL 2014; 18:225-31. [PMID: 25326021 PMCID: PMC4225062 DOI: 10.6091/ibj.13222.2014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2013] [Revised: 03/09/2014] [Accepted: 03/11/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND Accidents are the second reason for mortality and morbidity in Iran. Among them, brain injuries are the most important damage. Clarification of the effects of brain injuries on different body systems will help physicians to prioritize their treatment strategies. In this study, the effect of pure brain trauma on the cardiovascular system and lungs 24 hours post trauma was assessed. METHODS Male Wistar rats (n = 32) were divided into sham control and traumatic brain injury (TBI) groups. In TBI animals, under deep anesthesia, a blow to the head was induced by the fall of a 450 g weight from 2 m height. Twenty four hours later, heart electrocardiogram and functional indices, cardiac troponin I, IL-6, TNF-, IL-I in tissue and serum, and the histopathology of heart and lung were assessed. RESULTS The results showed that none of the functional, biochemical, inflammatory, and histopathology indices was statistically different between the two groups at 24 hours post TBI. Indices of impulse conduction velocity in atrium (P wave duration and P-R interval) were significantly longer in the TBI group. CONCLUSION Overall, no important functional and histopathologic disturbances were found in heart and lung of TBI group after 24 hours. If the data is reproduced in human studies, the medical team could allocate their priority to treatment of brain disorders of the victim in the first 24 hours of pure TBI and postpone extensive assessment of heart and lung health indices to later time, thus reducing patient and health system expenditures.
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Affiliation(s)
- Hamid Najafipour
- Physiology Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran;
| | | | - Mohammad Khaksari
- Physiology Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran;
| | - Beydolah Shahouzehi
- Physiology Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran;
| | - Siyavash Joukar
- Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Hamid Reza Poursalehi
- Physiology Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran;
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Abstract
Aneurysmal subarachnoid haemorrhage (SAH) is a devastating disease associated with high mortality and poor outcome in many survivors. Aggressive treatment by a comprehensive multidisciplinary team is associated with improved outcome, but the intensive care management of SAH presents significant challenges. Multimodal neuromonitoring may detect secondary insults before irreversible neuronal damage has occurred, and is increasingly being used to guide treatment. This article reviews current trends in the intensive care management of SAH from aspects of initial resuscitation to recent developments in the prevention and management of complications, including delayed cerebral ischaemia. Evidence from clinical trials and recent consensus guidance is reviewed.
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Affiliation(s)
- David Highton
- Academic Clinical Fellow in Anaesthesia and Critical Care, University College London Hospitals
| | - Martin Smith
- Consultant and Honorary Professor in Neurocritical Care, The National Hospital for Neurology and Neurosurgery, University College London Hospitals
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Skrifvars MB, Parr MJ. Incidence, predisposing factors, management and survival following cardiac arrest due to subarachnoid haemorrhage: a review of the literature. Scand J Trauma Resusc Emerg Med 2012; 20:75. [PMID: 23151345 PMCID: PMC3522540 DOI: 10.1186/1757-7241-20-75] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Accepted: 11/08/2012] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION The prevalence of cardiac arrest among patients with subarachnoid haemorrhage [SAH], and the prevalence of SAH as the cause following out-of-hospital cardiac arrest [OHCA] or in-hospital cardiac arrest [IHCA] is unknown. In addition it is unclear whether cardiopulmonary resuscitation [CPR] and post-resuscitation care management differs, and to what extent this will lead to meaningful survival following cardiac arrest [CA] due to SAH. AIM We reviewed the literature in order to describe; 1.The prevalence and predisposing factors of CA among patients with SAH 2.The prevalence of SAH as the cause of OHCA or IHCA and factors characterising CPR 3.The survival and management of SAH patients with CA. MATERIAL AND METHODS The following sources, PubMed, CinAHL and The Cochrane DataBase were searched using the following Medical Subheadings [MeSH]; 1. OHCA, IHCA, heart arrest and 2. subarachnoid haemorrhage. Articles containing relevant data based on the abstract were reviewed in order to find results relevant to the proposed research questions. Manuscripts in other languages than English, animal studies, reviews and case reports were excluded. RESULTS A total of 119 publications were screened for relevance and 13 papers were included. The prevalence of cardiac or respiratory arrest among all patients with SAH is between 3-11%, these patients commonly have a severe SAH with coma, large bleeds and evidence of raised intracerebral pressure on computed tomography scans compared to those who did not experience a CA. The prevalence of patients with SAH as the cause of the arrest among OHCA cases vary between 4 to 8% among those who die before hospital admission, and between 4 to 18% among those who are admitted. The prevalence of SAH as the cause following IHCA is low, around 0.5% according to one recent study. In patients with OHCA survival to hospital discharge is poor with 0 to 2% surviving. The initial rhythm is commonly asystole or pulseless electrical tachycardia. In IHCA the survival rate is variable with 0-27% surviving. All survivors experience brief cardiac arrests with short latencies to ROSC. CONCLUSION Cardiac arrest is a fairly common complication following severe SAH and these patients are encountered both in the pre-hospital and in-hospital setting. Survival is possible if the arrest occurs in the hospital and the latency to ROSC is short. In OHCA the outcome seems to be uniformly poor despite initially successful resuscitation.
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Affiliation(s)
- Markus B Skrifvars
- Department of Anaesthesiology and Intensive Care Medicine, Helsinki University Hospital, Helsinki, Finland.
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Cardiovascular changes after subarachnoid hemorrhage initiated by the trigeminocardiac reflex-first description of a case series. J Neurosurg Anesthesiol 2012; 23:379-80. [PMID: 21908992 DOI: 10.1097/ana.0b013e3182312486] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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INAMASU J, NAKATSUKASA M, MAYANAGI K, MIYATAKE S, SUGIMOTO K, HAYASHI T, KATO Y, HIROSE Y. Subarachnoid Hemorrhage Complicated With Neurogenic Pulmonary Edema and Takotsubo-Like Cardiomyopathy. Neurol Med Chir (Tokyo) 2012; 52:49-55. [DOI: 10.2176/nmc.52.49] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Joji INAMASU
- Department of Neurosurgery, Fujita Health University School of Medicine
- Department of Neurosurgery, Saiseikai Utsunomiya Hospital
| | | | - Keita MAYANAGI
- Department of Neurosurgery, Saiseikai Utsunomiya Hospital
| | - Satoru MIYATAKE
- Department of Emergency Medicine, Saiseikai Utsunomiya Hospital
| | - Keiko SUGIMOTO
- Department of Laboratory Medicine, Fujita Health University School of Medicine
| | - Takuro HAYASHI
- Department of Neurosurgery, Fujita Health University School of Medicine
| | - Yoko KATO
- Department of Neurosurgery, Fujita Health University School of Medicine
| | - Yuichi HIROSE
- Department of Neurosurgery, Fujita Health University School of Medicine
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Mitsuma W, Ito M, Kodama M, Takano H, Tomita M, Saito N, Oya H, Sato N, Ohashi S, Kinoshita H, Kazama JJ, Honda T, Endoh H, Aizawa Y. Clinical and cardiac features of patients with subarachnoid haemorrhage presenting with out-of-hospital cardiac arrest. Resuscitation 2011; 82:1294-7. [DOI: 10.1016/j.resuscitation.2011.05.019] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2010] [Revised: 04/19/2011] [Accepted: 05/16/2011] [Indexed: 11/15/2022]
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Kitamura Y, Nomura M, Shima H, Kuwana N, Kuramitsu T, Chang CC, Bando K, Shibata I, Nishikawa H. Acute lung injury associated with systemic inflammatory response syndrome following subarachnoid hemorrhage: a survey by the Shonan Neurosurgical Association. Neurol Med Chir (Tokyo) 2011; 50:456-60. [PMID: 20587968 DOI: 10.2176/nmc.50.456] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Acute lung injury (ALI) associated with systemic inflammatory response syndrome (SIRS) is a systemic complication following subarachnoid hemorrhage (SAH), but the incidence and influence on prognosis are unclear. The incidences of SIRS and ALI were surveyed in a prospective multicenter study of 96 patients admitted for SAH between December 2004 and June 2007. Hunt and Hess grade and Glasgow Outcome Scale score were also investigated. Forty-eight patients were diagnosed with SIRS, and 26 developed ALI within 4 weeks of admission. Nineteen of the 26 patients with ALI were complicated by SIRS, and 7 developed only ALI. Thirteen of the 19 patients complicated by SIRS and ALI died, and this mortality was higher than for patients with only SIRS (3/29) and only ALI (1/7). Multivariate analysis of the development of SIRS and/or ALI and Hunt and Hess grade as risk factors associated with aggravation of the outcome showed that complication with SIRS and ALI had the highest risk. Half of the patients admitted for SAH developed SIRS, and more than 25% developed ALI. The prognosis for patients complicated by SIRS and ALI was poor, which indicates that prevention and active treatment of these two pathologies are important.
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Affiliation(s)
- Yoshihisa Kitamura
- Department of Neurosurgery, Yokohama Sakae Kyosai Hospital, Yokohama, Kanagawa, Japan.
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Transient left ventricular apical ballooning in a patient with cardiac arrest after subarachnoid hemorrhage. J Cardiol Cases 2011; 3:e33-e36. [PMID: 30532830 DOI: 10.1016/j.jccase.2010.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Revised: 07/15/2010] [Accepted: 08/16/2010] [Indexed: 11/21/2022] Open
Abstract
Subarachnoid hemorrhage (SAH) often accompanies cardiac abnormalities. Sudden cardiac arrest is also known to occur after SAH. A 32-year-old woman was admitted to our hospital because of cardiac arrest immediately after the onset of SAH. Return of spontaneous circulation was obtained by conventional advanced cardiovascular life support. After resuscitation, her echocardiogram showed left ventricular apical ballooning, which improved within 7 days. This is the first report presenting both sudden cardiac arrest and transient left ventricular apical ballooning after SAH.
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Affiliation(s)
- Wataru Mitsuma
- Division of Cardiology, Niigata University Graduate School of Medical and Dental Sciences, Japan.
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Miketic JK, Hravnak M, Sereika SM, Crago EA. Elevated cardiac troponin I and functional recovery and disability in patients after aneurysmal subarachnoid hemorrhage. Am J Crit Care 2010; 19:522-8; quiz 529. [PMID: 20107235 DOI: 10.4037/ajcc2010156] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Patients with aneurysmal subarachnoid hemorrhage experience myocardial injury at the time of rupture, but its effect on functional recovery and disability is unclear. OBJECTIVE To describe the prevalence of myocardial injury, as indicated by high serum levels of cardiac troponin I (≥0.3 ng/mL), within the first 5 days after aneurysmal subarachnoid hemorrhage and the effect of the injury on 3-month functional recovery and disability. METHODS In a prospective longitudinal study, 239 patients with Hunt/Hess grade 3 or greater and/or Fisher grade 2 or greater at admission had serum level of troponin I measured on days 0 to 5. Patients were interviewed at 3 months to evaluate functional recovery (Glasgow Outcome Scale) and functional disability (Modified Rankin Scale). Statistics included χ² analysis, t tests, and binary logistic regression. RESULTS Troponin values were elevated in 33.5% of the patients, and few patients in either group had a history of coronary artery disease (7.4% with troponin levels ≥0.3 ng/mL vs 2.7% with levels <0.3 ng/mL, P = .12). Higher troponin levels were significantly related to age and Hunt/Hess and Fisher grades, but not race, and were significantly associated with poorer functional recovery (P < .001) and more functional disability (P < .001). Even after controls for age, race, and more severe Hunt/Hess grades, higher levels remained a significant predictor of poorer functional recovery (P = .04) and disability (P = .01). CONCLUSION Elevated levels of cardiac troponin I after aneurysmal subarachnoid hemorrhage are common in patients with no cardiac history, are associated with severity of the hemorrhage, and are independently predictive of poorer functional recovery and increased disability.
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Affiliation(s)
- Joyce K. Miketic
- Joyce K. Miketic is a graduate student researcher, Marilyn Hravnak is a professor, and Elizabeth A. Crago is a clinical coordinator in the Department of Acute and Tertiary Care at the University of Pittsburgh, School of Nursing, Pittsburgh, Pennsylvania. Susan M. Sereika is an associate professor in the Department of Health and Community Systems in the School of Nursing and the Department of Biostatistics in the Graduate School of Public Health at the University of Pittsburgh
| | - Marilyn Hravnak
- Joyce K. Miketic is a graduate student researcher, Marilyn Hravnak is a professor, and Elizabeth A. Crago is a clinical coordinator in the Department of Acute and Tertiary Care at the University of Pittsburgh, School of Nursing, Pittsburgh, Pennsylvania. Susan M. Sereika is an associate professor in the Department of Health and Community Systems in the School of Nursing and the Department of Biostatistics in the Graduate School of Public Health at the University of Pittsburgh
| | - Susan M. Sereika
- Joyce K. Miketic is a graduate student researcher, Marilyn Hravnak is a professor, and Elizabeth A. Crago is a clinical coordinator in the Department of Acute and Tertiary Care at the University of Pittsburgh, School of Nursing, Pittsburgh, Pennsylvania. Susan M. Sereika is an associate professor in the Department of Health and Community Systems in the School of Nursing and the Department of Biostatistics in the Graduate School of Public Health at the University of Pittsburgh
| | - Elizabeth A. Crago
- Joyce K. Miketic is a graduate student researcher, Marilyn Hravnak is a professor, and Elizabeth A. Crago is a clinical coordinator in the Department of Acute and Tertiary Care at the University of Pittsburgh, School of Nursing, Pittsburgh, Pennsylvania. Susan M. Sereika is an associate professor in the Department of Health and Community Systems in the School of Nursing and the Department of Biostatistics in the Graduate School of Public Health at the University of Pittsburgh
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Dronavalli VB, Banner NR, Bonser RS. Assessment of the Potential Heart Donor. J Am Coll Cardiol 2010; 56:352-61. [DOI: 10.1016/j.jacc.2010.02.055] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2009] [Revised: 01/19/2010] [Accepted: 02/16/2010] [Indexed: 11/29/2022]
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Nevin D, Lines D. Acute subarachnoid haemorrhage and the mysterious electrocardiogram. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2010. [DOI: 10.1080/22201173.2010.10872675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Systemic Complications after Subarachnoid Hemorrhage. Intensive Care Med 2010. [DOI: 10.1007/978-1-4419-5562-3_40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Nakamura T, Okuchi K, Matsuyama T, Fukushima H, Seki T, Konobu T, Nishio K. Clinical significance of elevated natriuretic peptide levels and cardiopulmonary parameters after subarachnoid hemorrhage. Neurol Med Chir (Tokyo) 2009; 49:185-91; discussion 191-2. [PMID: 19465787 DOI: 10.2176/nmc.49.185] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Daily changes in serum concentrations of natriuretic peptides and various cardiopulmonary parameters were measured after the onset of subarachnoid hemorrhage (SAH) to investigate the pathogenesis of the cardiac and pulmonary consequences in 15 patients with acute phase SAH, divided into the control group (n = 5) with consciousness continuously preserved from SAH onset to admission, and the consciousness disturbance group (n = 10). Daily changes in serum A-type and B-type natriuretic peptides (ANP and BNP, respectively) were measured for 10 days, and intrathoracic blood volume index and extravascular lung water index (EVLWI) were measured for 5 days by the single transpulmonary thermodilution method. Natriuretic peptides in the consciousness disturbance group showed significantly higher values during the 10-day period, with ANP 119.2 +/- 12.4 pg/ml (mean +/- standard error of the mean, p = 0.005) on day 2 and BNP 354.1 +/- 80.3 pg/ml (p = 0.009) on day 1. EVLWI showed higher values in the consciousness disturbance group compared to the control group throughout the 5-day period. The increases in natriuretic peptide levels and increase in pulmonary extravascular water content found in SAH patients with consciousness disturbance show that load on the left ventricle or atrium as well as pulmonary capillary pressure are increased immediately after onset, supporting the contention that excessive release of catecholamines occurs at this time.
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Affiliation(s)
- Tatsuya Nakamura
- Department of Emergency and Critical Care Medicine, Nara Medical University, Kashihara, Nara
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Sandvei MS, Amundsen BH, Haugen BO, Støylen A, Slørdahl SA, Vik A. Left ventricular myocardial function during the acute phase of a subarachnoid haemorrhage. SCAND CARDIOVASC J 2009; 43:110-6. [DOI: 10.1080/14017430802398116] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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[Elevated troponin and ECG alterations in acute ischemic stroke and subarachnoid hemorrhage]. DER NERVENARZT 2009; 79:1386, 1388-90, 1392-4, passim. [PMID: 18679640 DOI: 10.1007/s00115-008-2541-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Vascular diseases are the most common cause of death and disability in industrialised countries. Ischaemic heart disease and cerebrovascular disease frequently coexist in one patient. Therefore it is not surprising that raised troponin levels and ECG changes are detected comparatively often in acute stroke; however these changes do not always indicate myocardial infarction. Clinical and experimental data suggest that some kind of neurologically mediated myocardial injury exists--especially in subarachnoid hemorrhage--but not as a manifestation of concomitant ischaemic heart disease. This review summarises the frequency and possible pathophysiological mechanisms. In any case, raised troponin levels and ECG changes after acute stroke are of negative prognostic value, and a cardiological diagnostic work-up should be done.
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Kemp CD, Johnson JC, Riordan WP, Cotton BA. How We Die: The Impact of Nonneurologic Organ Dysfunction after Severe Traumatic Brain Injury. Am Surg 2008. [DOI: 10.1177/000313480807400921] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Although nonneurologic organ dysfunction (NNOD) has been shown to significantly affect mortality in subarachnoid hemorrhage, the contribution of NNOD to mortality after severe traumatic brain injury (TBI) has yet to be defined. We hypothesized that NNOD has a significant impact on mortality after severe TBI. The trauma registry was queried for all patients admitted between January 2004 and December 2004 who died during their initial hospitalization after severe TBI (head Abbreviated Injury Score 3 or greater). Cause of death and contributing factors to mortality were determined by an attending trauma surgeon from the medical record. The data were analyzed using both Fisher's exact and Wilcoxon rank sum. One hundred thirty-five patients met inclusion criteria. Sixty-seven per cent were males, 83 per cent were white, and the mean age was 38.5 years. Mean length of stay was 2.9 days. Fifty-four patients (40%) had isolated TBI (chest Abbreviated Injury Score = 0, abdominal Abbreviated Injury Score = 0). Of the 81 deaths attributed to a single cause, 48 (60%) patients died from nonsurvivable TBI or brain death, whereas 33 (40%) died of a nonneurologic cause. Cardiovascular and respiratory dysfunction (excluding pneumonia) contributed to mortality in 51.1 per cent and 34.1 per cent of patients, respectively. NNOD contributes to approximately two-thirds of all deaths after severe TBI. These complications occur early and are seen even among those with isolated head injuries. These findings demonstrate the impact of the extracranial manifestations of severe TBI on overall mortality and highlight potential areas for future intervention and research.
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Affiliation(s)
- Clinton D. Kemp
- From the Department of Surgery/Division of Trauma and Surgical Critical Care, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - J. Chad Johnson
- From the Department of Surgery/Division of Trauma and Surgical Critical Care, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - William P. Riordan
- From the Department of Surgery/Division of Trauma and Surgical Critical Care, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Bryan A. Cotton
- From the Department of Surgery/Division of Trauma and Surgical Critical Care, Vanderbilt University School of Medicine, Nashville, Tennessee
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Abstract
Treating patients with aneurysmal subarachnoid haemorrhage is taking care of acutely ill patients, and should be performed in centres where a multidisciplinary team is available 24 hours a day 7 days a week, and where enough patients are managed to maintain and improve standards of care. There is no medical management that improves outcome by reducing the risk of rebleeding, therefore occlusion of the aneurysm, nowadays preferably by means of coiling, remains an important goal in treating patients with aneurysms. Because the poor outcome after subarachnoid haemorrhage is caused to a large extent by complications other than rebleeding, proper medical management to prevent and treat these complications is therefore essential. On basis of the available evidence, oral (not intravenous) nimodipine should be standard care in patients with subarachnoid haemorrhage. It is rational to refrain from treating hypertension unless cardiac failure develops and to aim for normovolaemia, even in case of hyponatraemia. There is no evidence for prophylactic hypervolaemia, and the strategy of hypervolaemia and hypertension in patients with secondary cerebral ischaemia is based on case reports and uncontrolled observational series of patients. Magnesium sulphate and statins are promising therapies, and large trials on effectiveness in improving clinical outcome are underway. There is no evidence for prophylactic use of anti epileptic drugs, and routine use of corticosteroids should be avoided.
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Ferro JM, Canhão P, Peralta R. Update on subarachnoid haemorrhage. J Neurol 2008; 255:465-79. [DOI: 10.1007/s00415-008-0606-3] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2007] [Revised: 02/12/2007] [Accepted: 03/06/2007] [Indexed: 11/29/2022]
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Fujita K, Fukuhara T, Munemasa M, Numba Y, Kuyama H. Ampulla cardiomyopathy associated with aneurysmal subarachnoid hemorrhage: report of 6 patients. ACTA ACUST UNITED AC 2008; 68:556-61; discussion 561. [PMID: 17961746 DOI: 10.1016/j.surneu.2006.11.041] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2006] [Accepted: 11/01/2006] [Indexed: 10/22/2022]
Abstract
BACKGROUND The authors report 6 cases of aneurysmal SAH associated with ampulla cardiomyopathy, which has been considered a unique type of stunned myocaridum. CASE DESCRIPTION All patients were female, ranged from 35 to 79 years, and their echocardiograms revealed typical cardiac wall motions: the hypokinesia in the apical area of the left ventricle associated with the hyperkinesia in the basal area. In all, the cardiac function started to recover in the first few days; however, associated pulmonary congestions delayed aneurysmal surgeries in 3 patients. Among 3 patients whose surgeries were delayed, one died due to rerupture of aneurysm and another due to severe pneumonia. The other 4 patients recovered well, although one had left ventricular mural thrombus, which was treated successively with anticoagulant. CONCLUSIONS It is considered highly important for neurosurgeons to be familiar with this clinical entity, since this transient cardiac function disturbance can be diagnosed at the initial presentation with a unique wall motion. The significance and clinical features of ampulla cardiomyopathy are discussed.
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Affiliation(s)
- Kohei Fujita
- Department of Cardiology, Neuro-research Institute for Stroke Care, National Hospital Organization Okayama Medical Center, Okayama 701-1192, Japan
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Inoue M, Taniguchi T, Goto Y, Ohta K, Hirota Y, Hamada JI, Yamagishi M, Inaba H. Unusual abnormal left ventricular contraction pattern associated with subarachnoid hemorrhage. Intensive Care Med 2007; 33:2036-7. [PMID: 17576534 DOI: 10.1007/s00134-007-0740-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2007] [Accepted: 05/10/2007] [Indexed: 11/28/2022]
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Abstract
Aneurysmal subarachnoid hemorrhage (SAH) is analogous to a pathophysiological watershed, disrupting brain integrity and function and precipitating an array of systemic derangements including cardiovascular, respiratory, endocrine, hematological, and immune dysfunction. Extracerebral organ dysfunction is closely linked to the magnitude of the primary neurological insult, suggesting neurogenic, neuroendocrine and neuroimmunomodulatory mechanisms. Systemic organ involvement is associated with increased mortality and neurological impairment, even after adjustment for other outcome predictors such as the severity of the initial neurological injury. This may be a reflection of secondary brain injury precipitated by hypoxemia, circulatory failure, fever, or hyperglycemia, all of which have been linked to adverse clinical outcomes. Interventions to avert or reverse these and other perturbations need to be tested in clinical trials as they represent opportunities to improve survival and neurological recovery in patients with SAH.
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Affiliation(s)
- Robert D Stevens
- Department of Anesthesiology/Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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Lin NN, Kuo JS, Cheng CC, Tung KC, Cheng FC, Chiu YT. Early cardiac damage after subarachnoid hemorrhage in rats. Int J Cardiol 2007; 129:433-7. [PMID: 17689716 DOI: 10.1016/j.ijcard.2007.06.066] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2007] [Accepted: 06/23/2007] [Indexed: 11/20/2022]
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Noritomi DT, de Cleva R, Beer I, Dalbem AG, Libório AB, Frota NAF, Gama-Rodrigues JJ. Doctors awareness of spontaneous subarachnoid haemorrhage as a cause of cardiopulmonary arrest. Resuscitation 2006; 71:123-4. [PMID: 16942828 DOI: 10.1016/j.resuscitation.2006.06.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2006] [Revised: 06/21/2006] [Accepted: 06/21/2006] [Indexed: 11/26/2022]
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Ziegelstein RC, Thombs BD. The brain and the heart: the twain meetThe opinions expressed in this article are not necessarily those of the Editors of the European Heart Journal or of the European Society of Cardiology. Eur Heart J 2005; 26:2607-8. [PMID: 16227312 DOI: 10.1093/eurheartj/ehi576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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In this issue. Resuscitation 2005. [DOI: 10.1016/s0300-9572(05)00137-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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