Delayed Normalization of Electrocardiograms in Patients with Takotsubo Cardiomyopathy due to Aneurysmal Subarachnoid Hemorrhage

Clinical characteristics of aneurysmal subarachnoid haemorrhage complicated by Takotsubo cardiomyopathy resulting in good neurological outcome

BACKGROUND

Takotsubo cardiomyopathy (TC) is a well-known complication of subarachnoid haemorrhage (SAH), often accompanied by neurogenic myocardial dysfunction. Although TC has been reported to be associated with higher morbidity and mortality among patients with aneurysmal SAH (aSAH), some patients have been reported to recover, the profiles and follow-up outcomes of these survivors remain unclear.

MATERIALS AND METHODS

To characterize the profiles of patients with aSAH complicated by TC who experienced favourable outcomes using long-term follow-up data, a consecutive series of patients with aSAH were enrolled and TC diagnosis was based on the revised version of the Mayo Clinic criteria. Clinical outcomes were assessed at 6 months according to modified Rankin Scale scores.

RESULTS

Among 165 consecutive patients with aSAH, 15 cases were complicated by TC, corresponding to an occurrence rate of 9.0%. Five patients with aSAH complicated by TC (33.3%) experienced a favourable outcome, and the mean value of systolic blood pressure on arrival was significantly lower than in those who experienced an unfavourable outcome (p = 0.032).

CONCLUSION

According to analysis, it is possible cardiac dysfunction with decreased cerebral perfusion pressure and catecholamine toxicity transiently worsens conscious disturbance in aSAH complicated by TC. Therefore, it is important to carefully screen patients with aSAH to identify those complicated by TC, and for close collaboration of the multidisciplinary team to design appropriate treatment strategies.

Reversible Stress Cardiomyopathy Secondary to Aneurysmal Subarachnoid Hemorrhage: A Case Report

BACKGROUND

Acute cerebral incidents have been correlated with cardiac manifestations. Specifically, subarachnoid hemorrhage has been correlated with a syndrome described as neurogenic stress cardiomyopathy and mimics acute coronary syndrome.

CASE REPORT

A 55-year-old woman presented at the Emergency Department of our hospital complaining of vomiting and headache of sudden onset. Computed tomography angiography revealed a ruptured aneurysm at the tip of the basilar artery and the patient underwent a successful complete embolism of the sac of the aneurysm. During hospitalization, the patient developed electrocardiographic alterations and elevation of cardiac biomarkers, and echocardiography showed an impairment of left ventricular systolic function. The patient was diagnosed with neurogenic stress cardiomyopathy and she was treated conservatively. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Clinicians should be aware of neurogenic stress cardiomyopathy because early diagnosis and treatment are the cornerstones for achieving a better outcome.