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Murthy SB, Shah S, Rao CPV, Bershad EM, Suarez JI. Neurogenic Stunned Myocardium Following Acute Subarachnoid Hemorrhage. J Intensive Care Med 2013; 30:318-25. [DOI: 10.1177/0885066613511054] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Accepted: 09/03/2013] [Indexed: 01/01/2023]
Abstract
Neurogenic stunned myocardium (NSM) is a triad of transient left ventricular dysfunction, electrocardiogram changes, and elevation in cardiac enzymes, often mimicking a myocardial infarction. It has been described following acute brain injury. The purported mechanism is catecholamine excess resulting in cardiac dysfunction. From the clinical standpoint, the most frequently encountered electrocardiographic changes are QTc prolongation and ST-T changes, with modest elevations in troponin levels. Basal and mid-ventricular segments of the left ventricle are most commonly involved. NSM poses therapeutic challenges when it occurs secondary to aneurysmal subarachnoid hemorrhage, particularly in the setting of coexisting vasospasm. Overall, NSM carries good prognosis if recognized early, with appropriate management of hemodynamic and cardiopulmonary parameters.
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Affiliation(s)
- Santosh B. Murthy
- Department of Vascular Neurology and Neurocritical Care, Baylor College of Medicine, Houston, TX, USA
| | - Shreyansh Shah
- Department of Vascular Neurology and Neurocritical Care, Baylor College of Medicine, Houston, TX, USA
| | | | - Eric M. Bershad
- Department of Vascular Neurology and Neurocritical Care, Baylor College of Medicine, Houston, TX, USA
| | - Jose I. Suarez
- Department of Vascular Neurology and Neurocritical Care, Baylor College of Medicine, Houston, TX, USA
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Naidech AM, Bassin SL, Garg RK, Ault ML, Bendok BR, Batjer HH, Watts CM, Bleck TP. Cardiac troponin I and acute lung injury after subarachnoid hemorrhage. Neurocrit Care 2009; 11:177-82. [PMID: 19407934 DOI: 10.1007/s12028-009-9223-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2009] [Accepted: 04/15/2009] [Indexed: 01/06/2023]
Abstract
INTRODUCTION There are few predictors of acute lung injury (ALI) or the acute respiratory distress syndrome (ARDS) after subarachnoid hemorrhage (SAH). We hypothesized that cardiac troponin I, which is associated with cardiovascular morbidity, would also predict ALI. METHODS We prospectively enrolled 171 consecutive patients with SAH. Troponin was routinely measured on admission and the next day and subsequently if abnormal. We prospectively recorded the maximum troponin, in-hospital events, and clinical endpoints. ALI and ARDS were defined by standard criteria. RESULTS Acute lung injury was found in 10 patients (6%), ARDS in an additional 14 (8%), and pulmonary edema without lung injury in 9 (5%). Maximum troponin was different in patients without lung injury or pulmonary edema (0.03 [0.02-0.12] mcg/l), ALI (0.17 [0.04-1.4]), or ARDS (0.31 [0.9-1.8], P < 0.001). In ROC analysis, a cutoff of 0.04 mcg/l had 91% sensitivity and 42% specificity for ALI or ARDS (AUC = 0.75, P < 0.001). Troponin was associated with ALI or ARDS after accounting for neurologic grade in multivariate models without further contribution from pneumonia, packed red cell transfusion, gender, tobacco use, coronary artery disease, vasospasm, depressed ejection fraction on echocardiography, or CT grade. Lung injury was associated with worse functional outcome at 14 days, but not at 28 days or 3 months. CONCLUSION Troponin I is associated with the development of ALI after SAH.
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Affiliation(s)
- Andrew M Naidech
- Department of Neurology, Northwestern University Feinberg School of Medicine, 710 N Lake Shore Drive, Chicago, IL 60611, USA.
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Bahloul M, Chaari AN, Kallel H, Khabir A, Ayadi A, Charfeddine H, Hergafi L, Chaari AD, Chelly HE, Hamida CB, Rekik N, Bouaziz M. Neurogenic Pulmonary Edema Due to Traumatic Brain Injury: Evidence of Cardiac Dysfunction. Am J Crit Care 2006. [DOI: 10.4037/ajcc2006.15.5.462] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
• Background Acute neurogenic pulmonary edema, a common and underdiagnosed clinical entity, can occur after virtually any form of injury of the central nervous system and is a potential early contributor to pulmonary dysfunction in patients with head injuries.
• Objective To explore myocardial function in patients with evident neurogenic pulmonary edema after traumatic head injury.
• Methods During a 1-year period in a university hospital in Sfax, Tunisia, information was collected prospectively on patients admitted to the 22-bed intensive care unit because of isolated traumatic head injury who had neurogenic pulmonary edema. Data included demographic information, vital signs, neurological status, physiological status, and laboratory findings. All of the patients had computed tomography and plain radiography of the neck and determination of cardiac function.
• Results All 7 patients in the sample had cardiac dysfunction. Evidence of myocardial damage was confirmed by echocardiography in 3 patients, pulmonary artery catheterization in 3 patients, and/or postmortem myocardial biopsy in 4 patients. Echocardiography studies, repeated 7 days after the initial study in one patient and 90 days afterward in another, showed complete improvement in wall motion, with a left ventricular ejection fraction of 0.65.
• Conclusion All patients who had neurogenic pulmonary edema due to traumatic head injury had myocardial dysfunction. The mechanisms of the dysfunction were multiple. The great improvement in wall motion seen in 2 patients indicated the presence of a stunned myocardium. Further studies are needed to understand the mechanisms of this cardiac dysfunction.
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Affiliation(s)
- Mabrouk Bahloul
- Service de Réanimation Médicale (mb, anc, hk, lh, adc, hec, cbh, nr, mb), Service d’Anatomopathologie (ak), and Service de Médecine Légale (aa), Centre Hospitalier Universitaire Habib Bourguiba, Sfax, Tunisia, and Service de Cardiologie, Centre Hospitalier Universitaire Hédi Chaker, Sfax, Tunisia (hc)
| | - Anis N. Chaari
- Service de Réanimation Médicale (mb, anc, hk, lh, adc, hec, cbh, nr, mb), Service d’Anatomopathologie (ak), and Service de Médecine Légale (aa), Centre Hospitalier Universitaire Habib Bourguiba, Sfax, Tunisia, and Service de Cardiologie, Centre Hospitalier Universitaire Hédi Chaker, Sfax, Tunisia (hc)
| | - Hatem Kallel
- Service de Réanimation Médicale (mb, anc, hk, lh, adc, hec, cbh, nr, mb), Service d’Anatomopathologie (ak), and Service de Médecine Légale (aa), Centre Hospitalier Universitaire Habib Bourguiba, Sfax, Tunisia, and Service de Cardiologie, Centre Hospitalier Universitaire Hédi Chaker, Sfax, Tunisia (hc)
| | - Abdelmajid Khabir
- Service de Réanimation Médicale (mb, anc, hk, lh, adc, hec, cbh, nr, mb), Service d’Anatomopathologie (ak), and Service de Médecine Légale (aa), Centre Hospitalier Universitaire Habib Bourguiba, Sfax, Tunisia, and Service de Cardiologie, Centre Hospitalier Universitaire Hédi Chaker, Sfax, Tunisia (hc)
| | - Adnène Ayadi
- Service de Réanimation Médicale (mb, anc, hk, lh, adc, hec, cbh, nr, mb), Service d’Anatomopathologie (ak), and Service de Médecine Légale (aa), Centre Hospitalier Universitaire Habib Bourguiba, Sfax, Tunisia, and Service de Cardiologie, Centre Hospitalier Universitaire Hédi Chaker, Sfax, Tunisia (hc)
| | - Hanène Charfeddine
- Service de Réanimation Médicale (mb, anc, hk, lh, adc, hec, cbh, nr, mb), Service d’Anatomopathologie (ak), and Service de Médecine Légale (aa), Centre Hospitalier Universitaire Habib Bourguiba, Sfax, Tunisia, and Service de Cardiologie, Centre Hospitalier Universitaire Hédi Chaker, Sfax, Tunisia (hc)
| | - Leila Hergafi
- Service de Réanimation Médicale (mb, anc, hk, lh, adc, hec, cbh, nr, mb), Service d’Anatomopathologie (ak), and Service de Médecine Légale (aa), Centre Hospitalier Universitaire Habib Bourguiba, Sfax, Tunisia, and Service de Cardiologie, Centre Hospitalier Universitaire Hédi Chaker, Sfax, Tunisia (hc)
| | - Adel D. Chaari
- Service de Réanimation Médicale (mb, anc, hk, lh, adc, hec, cbh, nr, mb), Service d’Anatomopathologie (ak), and Service de Médecine Légale (aa), Centre Hospitalier Universitaire Habib Bourguiba, Sfax, Tunisia, and Service de Cardiologie, Centre Hospitalier Universitaire Hédi Chaker, Sfax, Tunisia (hc)
| | - Hedi E. Chelly
- Service de Réanimation Médicale (mb, anc, hk, lh, adc, hec, cbh, nr, mb), Service d’Anatomopathologie (ak), and Service de Médecine Légale (aa), Centre Hospitalier Universitaire Habib Bourguiba, Sfax, Tunisia, and Service de Cardiologie, Centre Hospitalier Universitaire Hédi Chaker, Sfax, Tunisia (hc)
| | - Chokri Ben Hamida
- Service de Réanimation Médicale (mb, anc, hk, lh, adc, hec, cbh, nr, mb), Service d’Anatomopathologie (ak), and Service de Médecine Légale (aa), Centre Hospitalier Universitaire Habib Bourguiba, Sfax, Tunisia, and Service de Cardiologie, Centre Hospitalier Universitaire Hédi Chaker, Sfax, Tunisia (hc)
| | - Noureddine Rekik
- Service de Réanimation Médicale (mb, anc, hk, lh, adc, hec, cbh, nr, mb), Service d’Anatomopathologie (ak), and Service de Médecine Légale (aa), Centre Hospitalier Universitaire Habib Bourguiba, Sfax, Tunisia, and Service de Cardiologie, Centre Hospitalier Universitaire Hédi Chaker, Sfax, Tunisia (hc)
| | - Mounir Bouaziz
- Service de Réanimation Médicale (mb, anc, hk, lh, adc, hec, cbh, nr, mb), Service d’Anatomopathologie (ak), and Service de Médecine Légale (aa), Centre Hospitalier Universitaire Habib Bourguiba, Sfax, Tunisia, and Service de Cardiologie, Centre Hospitalier Universitaire Hédi Chaker, Sfax, Tunisia (hc)
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