1
|
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.
Collapse
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
| |
Collapse
|
2
|
Choi YF, Siu AYC, Wong TW, Lau CC. ST Elevation is not Always Equivalent to Acute Myocardial Infarction: a Case of Brugada Syndrome. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490790301000209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Acute myocardial infarction (AMI) is one of the most alerting situations in emergency department. Electrocardiogram (ECG) is one of the most important diagnostic tools and the decision about thrombolytic therapy is usually based upon ECG findings when clinically suspicious. However, ST segment elevation is not always equivalent to acute myocardial infarction. We present a rare syndrome whose ECG shows persistent ST elevation not related to AMI.
Collapse
Affiliation(s)
- YF Choi
- Pamela Youde Nethersole Eastern Hospital, Accident and Emergency Department, 3 Lok Man Road, Chaiwan, Hong Kong
| | - AYC Siu
- North District Hospital, Accident and Emergency Department, 9 Po Kin Road, Sheung Shui, N.T., Hong Kong
| | - TW Wong
- Pamela Youde Nethersole Eastern Hospital, Accident and Emergency Department, 3 Lok Man Road, Chaiwan, Hong Kong
| | - CC Lau
- Pamela Youde Nethersole Eastern Hospital, Accident and Emergency Department, 3 Lok Man Road, Chaiwan, Hong Kong
| |
Collapse
|
3
|
Cheon YJ, Pyun WB, Lee DH, Choi YH. A Case of Electrocardiographic Change Caused by Subarachnoid Haemorrhage Mimicking Acute Myocardial Infarction. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791201900311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A 60-year-old woman was admitted to the emergency department due to syncope. The electrocardiogram (ECG) revealed normal sinus rhythm with ST segment elevation in leads I, II, and aVL. There was no stenosis or vasospasm in the coronary arteries. Transient electrocardiographic ST segment elevation which is indistinguishable from that associated with acute myocardial infarction has been reported in patients with subarachnoid hemorrhage (SAH). Until now no case was ever reported with the ECG finding with pattern of posterolateral myocardial infarction in SAH patients. So we describe a patient with SAH mimicking acute myocardial infarction.
Collapse
Affiliation(s)
| | - WB Pyun
- Ewha Womans University, Department of Cardiology, Seoul, Korea
| | - DH Lee
- Eulji University, Department of Emergency Medicine, Seoul, Korea
| | | |
Collapse
|
4
|
Redfors B, Shao Y, Wikström J, Lyon AR, Oldfors A, Gan LM, Omerovic E. Contrast echocardiography reveals apparently normal coronary perfusion in a rat model of stress-induced (Takotsubo) cardiomyopathy. Eur Heart J Cardiovasc Imaging 2013; 15:152-7. [PMID: 23832950 DOI: 10.1093/ehjci/jet079] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS Stress-induced cardiomyopathy (SIC) is an important differential diagnosis to acute myocardial infarction (AMI) that is associated with significant morbidity and mortality. The typical hallmark of SIC is left-ventricular apical akinesia but preserved function in basal segments. Catecholamines are postulated to play an important role in SIC but the precise pathophysiology is incompletely understood. Whether myocardial perfusion of the affected segments is impaired in SIC has been debated and remains unknown. METHODS AND RESULTS Myocardial contrast echocardiography (MCE) was used to study regional myocardial perfusion in a rat model of SIC. Twelve rats received 50 mg/kg isoproterenol (ISO) i.p. and were continuously monitored by MCE. Apical and basal perfusion were estimated and expressed as a ratio at baseline, 5, 10, 20, 30, 40, 50, 60, 70, 80, and 90 min post-ISO. The rats developed typical apical ballooning after 43 ± 9 min post-ISO injection. The ratio of apical:basal perfusion was close to 1.00 at all time-points and never dropped below 0.89 (95% CI never extended below 0.73). Light and electron microcoscopical investigation revealed no structural damage of myocardial vessels. CONCLUSION Apical perfusion is not impaired in the early phase of SIC in this rat model.
Collapse
Affiliation(s)
- Bjorn Redfors
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy at University of Gothenburg, Bruna stråket 16, SE 413 45 Gothenburg, Sweden
| | | | | | | | | | | | | |
Collapse
|
5
|
Chen HY. Angiographic Coronary Spasm in a Case of Spontaneous Subarachnoid Hemorrhage Mimicking Acute Myocardial Infarction. Cardiol Res 2013; 4:74-77. [PMID: 28352424 PMCID: PMC5358217 DOI: 10.4021/cr269w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2013] [Indexed: 01/05/2023] Open
Abstract
Neurologic stunned myocardium after subarachnoid hemorrhage (SAH) has been evidenced. Clinical presentations manifested as ST segment elevation by electrocardiography (ECG), left ventricular wall motion abnormality by echocardiography, and abnormal cardiac markers. The pathophysiology remains controversial. Coronary artery spasm has been proposed as a possible mechanism. However, most SAH patients with ECG and echocardiographic findings suggestive of myocardial infarction were lacking of angiographic evidence of vasospasm. We present a case of 66-year-old man complained chest pain with transient conscious loss on the street. He was sent to our emergency room by witness with clear consciousness and electrocardiography showing prominent ST-segment elevation. Because chest tightness was complained, emergent catheterization was arranged immediately. Coronary angiography demonstrated a narrowing lesion on mid right coronary artery without atherosclerotic change on other site. He was successfully treated with primary coronary balloon angioplasty for the narrowing lesion. Then the patient was sent to intensive care unit for further care. His following ECG demonstrated sinus rhythm with ectopic beats without ST segment elevation. Unfortunately, he became irritable and deterioration of conscious level few hour later. Computer tomography revealed subdural and subarachnoid hemorrhage. Conservative treatment was suggested by neurological surgeon consulted. The clinical presentation of the SAH patient mimicked acute myocardial infarction and coronary spasm was evidenced by angiography. We report the case and review the articles.
Collapse
Affiliation(s)
- Hung Yi Chen
- Department of Cardiology, Taipei City Hospital-Heping Branch, No. 33, Sec. 2, Zhonghua Rd., Taipei City 100, Taiwan.
| |
Collapse
|
6
|
Chang NC, Lin MS, Huang CY, Shih CM, Bi WF. Reversible left ventricular apical ballooning associated with jet lag in a Taiwanese woman: A case report. Int J Angiol 2012; 16:62-5. [PMID: 22477274 DOI: 10.1055/s-0031-1278250] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Reversible left ventricular apical ballooning, without coronary artery stenosis, is a novel heart syndrome mimicking acute myocardial infarction, and is very rare in Taiwan. A 74-year-old Taiwanese woman returned from travelling abroad for one week and suffered from persistent, severe jet lag with sleep disturbance. She had a cold exacerbated by bronchial asthma for three days. She presented with sudden onset of chest pain after drinking three cups of coffee and taking a sauna for more than 1 h. On admission, an electrocardiogram showed ST segment elevation in leads II, III, aVF and V(3-6), and cardiac enzyme tests revealed minimal elevation. An echocardiogram showed apical ballooning and basal hyperkinesias of the left ventricle (LV) in systole. A coronary angiogram on the second day was normal, while the ST segment was still elevated, and the patient continued to experience chest pain. A negative T wave developed three days later. The electrocardiogram abnormality and LV dysfunction resolved completely six months later. A takotsubo (ampulla) cardiomyopathy was diagnosed. The activated myocardial adrenergic nervous system, stimulated by acute and marked stress in this patient, with more adrenergic innervations distributed in the apex of the LV, may be the trigger for this novel cardiac syndrome.
Collapse
Affiliation(s)
- Nen-Chung Chang
- Division of Cardiology, Department of Internal Medicine, Taipei Medical University Hospital
| | | | | | | | | |
Collapse
|
7
|
Intracranial hemorrhage causes a transmural myocardial infarction without the presence of coronary atherosclerosis. Int J Cardiol 2011; 152:e40-1. [DOI: 10.1016/j.ijcard.2010.10.077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Accepted: 10/23/2010] [Indexed: 11/19/2022]
|
8
|
Apostolakis E, Parissis H, Dougenis D. Brain Death and Donor Heart Dysfunction: Implications in Cardiac Transplantation. J Card Surg 2010; 25:98-106. [DOI: 10.1111/j.1540-8191.2008.00790.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
9
|
Urbaniak K, Merchant AI, Amin-Hanjani S, Roitberg B. Cardiac complications after aneurysmal subarachnoid hemorrhage. ACTA ACUST UNITED AC 2007; 67:21-8; discussion 28-9. [PMID: 17210289 DOI: 10.1016/j.surneu.2006.08.065] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2005] [Accepted: 08/21/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND Cardiac complications are frequently encountered by neurointensivists caring for patients with SAH. Our aim was to better characterize the natural history of various cardiac abnormalities in this population. We sought to determine the risk factors for cardiac abnormalities, patient outcome, and impact of treatment type on cardiac abnormalities. METHODS We performed a single center retrospective review of admissions of patients with aneurysmal SAH to the neurosurgical ICU in a large university hospital. Patient demographics, pertinent history, cardiac tests, hospital LOS, intervention type, and discharge outcome were collected. RESULTS Data from 266 patients were available for analysis. Of these patients, 50% (n = 133) demonstrated cardiac abnormalities as indicated by abnormal EKG, ECHO, or troponin I. Only age was determined to be an independent statistically significant predictor of cardiac abnormality (P = .01). There was no difference in mortality between the cardiac abnormality and control groups (P = .33). However, there was increased morbidity in the cardiac abnormality group as demonstrated by worse discharge disposition, in addition to increased length of hospital stay (22.6 vs 17.1 days, P < .01). The incidence of cardiac abnormalities was the same among surgical and endovascular treatment groups. CONCLUSIONS Cardiac abnormalities, including those that meet ACC criteria for MI, are common among patients with SAH. However, in contrast to cardiac events outside the context of SAH, these abnormalities do not increase mortality. They do, however, adversely affect discharge disposition and prolong hospital LOS. The type of aneurysm treatment does not affect the incidence or outcome of cardiac abnormalities.
Collapse
Affiliation(s)
- Klaudia Urbaniak
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL 60612, USA
| | | | | | | |
Collapse
|
10
|
Banki N, Kopelnik A, Tung P, Lawton MT, Gress D, Drew B, Dae M, Foster E, Parmley W, Zaroff J. Prospective analysis of prevalence, distribution, and rate of recovery of left ventricular systolic dysfunction in patients with subarachnoid hemorrhage. J Neurosurg 2006; 105:15-20. [PMID: 16871878 DOI: 10.3171/jns.2006.105.1.15] [Citation(s) in RCA: 139] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECT Subarachnoid hemorrhage (SAH) has been associated with cardiac injury and left ventricular (LV) dysfunction. The incidence and natural history of neurocardiogenic injury after SAH remains poorly understood. The objective of this study was to describe the incidence, time course, recovery rate, and segmental patterns of LV dysfunction after SAH. METHODS Echocardiography was performed three times over a 7-day period in 173 patients with SAH. The incidence of global (ejection fraction [EF] < 50%) and segmental (any regional wall-motion abnormality [RWMA]) LV dysfunction was measured. The time course of LV dysfunction was determined by comparing the prevalence of LVEF less than 50% and RWMA at 0 to 2, 3 to 5, and 6 to 8 days after SAH. The recovery rate was defined as the proportion of patients with partial or complete normalization of function. The distribution of RWMAs among 16 LV segments was also determined. An LVEF less than 50% was found in 15% of patients, and 13% had an RWMA with a normal LVEF. There was a trend toward increased dysfunction at 0 to 2 days after SAH, compared with 3 to 8 days after SAH. Recovery of LV function was observed in 66% of patients. The most frequently abnormal LV segments were the basal and middle ventricular portions of the anteroseptal and anterior walls. The apex was rarely affected. CONCLUSIONS Left ventricular systolic dysfunction occurs frequently after SAH and usually improves over time. The observed segmental patterns of LV dysfunction often do not correlate with coronary artery distributions.
Collapse
Affiliation(s)
- Nader Banki
- Division of Cardiology, University of California, San Francisco Medical Center, San Francisco, California, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Yasu T, Tone K, Kubo N, Saito M. Transient mid-ventricular ballooning cardiomyopathy: A new entity of Takotsubo cardiomyopathy. Int J Cardiol 2006; 110:100-1. [PMID: 15996774 DOI: 10.1016/j.ijcard.2005.05.060] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2005] [Accepted: 05/21/2005] [Indexed: 10/25/2022]
Abstract
We present a case of a 64-year-old man with transient mid-ventricular ballooning cardiomyopathy. Left ventriculography showed morphological differences with ballooning around the whole mid-portion of the left ventricle, although precipitating factors and clinical courses were similar to Takotsubo cardiomyopathy. We suspect that transient mid-ventricular ballooning cardiomyopathy is a new pathological entity in Takotsubo cardiomyopathy.
Collapse
|
12
|
Naidech A, Du Y, Kreiter KT, Parra A, Fitzsimmons BF, Lavine SD, Connolly ES, Mayer SA, Commichau C. Dobutamine versus milrinone after subarachnoid hemorrhage. Neurosurgery 2006; 56:21-6l discussion 26-7. [PMID: 15617582 DOI: 10.1227/01.neu.0000144780.97392.d7] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2004] [Accepted: 08/27/2004] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Neurogenic stunned myocardium is a well-recognized complication of subarachnoid hemorrhage. Dobutamine and milrinone are both used for neurogenic stunned myocardium, but there are few data comparing them after subarachnoid hemorrhage. METHODS We compared the physiological dose response of dobutamine and milrinone in patients with subarachnoid hemorrhage requiring a pulmonary artery catheter. We located 11 patients who received either inotrope. Physiological data were fitted to a mixed model accounting for drug, dose, and between-patient variation. RESULTS There were 11 patients who had 152 pulmonary artery catheter measurements. Two received both inotropes (but not within 4 h of each other), 2 only milrinone, and 7 only dobutamine. The groups had similar clinical and physiological characteristics. After adjustment for vasopressin, milrinone was significantly more potent in increasing cardiac output (P <0.0001) and stroke volume (P=0.03), while decreasing vascular resistance (P <0.0001) and systolic blood pressure (P=0.008), than dobutamine. CONCLUSION These data suggest that milrinone and dobutamine should be used in different clinical situations. Milrinone may be more effective in patients with severely depressed systolic function but who have at least normal vascular resistance and blood pressure and in whom raising cardiac output is the primary goal. Dobutamine may be superior when vascular resistance or blood pressure is low.
Collapse
Affiliation(s)
- Andrew Naidech
- Department of Neurology, Columbia University, New York, New York, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
13
|
McLaughlin N, Bojanowski MW, Girard F, Denault A. Pulmonary edema and cardiac dysfunction following subarachnoid hemorrhage. Can J Neurol Sci 2005; 32:178-85. [PMID: 16018152 DOI: 10.1017/s0317167100003942] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Pulmonary edema (PE) can occur in the early or late period following subarachnoid hemorrhage (SAH). The incidence of each type of PE is unknown and the association with ventricular dysfunction, both systolic and diastolic, has not been described. METHODS Retrospective chart review of 178 consecutive patients with SAH surgically treated over a three-year period. Patients with pulmonary edema diagnosed by a radiologist were included. Early onset SAH was defined as occurring within 12 hours. Cardiac function at the time of the PE was analyzed using hemodynamic and echocardiographic criteria of systolic and diastolic dysfunction. Pulmonary edema was observed in 42 patients (28.8%) and was more often delayed (89.4%). Evidence of cardiac involvement during PE varied between 40 to 100%. RESULTS AND CONCLUSIONS Pulmonary edema occurs in 28.8% of patients after SAH, and is most commonly delayed. Cardiac dysfunction, both systolic and diastolic, is commonly observed during SAH and could contribute to the genesis of PE after SAH.
Collapse
Affiliation(s)
- Nancy McLaughlin
- Department of Neurosurgery, Centre Hospitalier de l'Université de Montréal-Hôpital Notre-Dame, QC, Canada
| | | | | | | |
Collapse
|
14
|
de Chazal I, Parham WM, Liopyris P, Wijdicks EFM. Delayed cardiogenic shock and acute lung injury after aneurysmal subarachnoid hemorrhage. Anesth Analg 2005; 100:1147-1149. [PMID: 15781536 DOI: 10.1213/01.ane.0000147704.90285.2a] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Both cardiac and lung injury after aneurysmal subarachnoid hemorrhage has been attributed to an adrenergic surge. Cardiogenic shock is very uncommon. We describe a 55-yr-old woman with a delayed cardiogenic shock emerging within hours after aneurysmal rupture. Cardiac damage was documented by increased serum troponin T, CPK-mb fraction, and severe wall motion abnormality, which included an akinetic apex on echocardiography (ejection fraction of 33%). Her coronary angiogram was normal. Decreased cardiac index, increased systemic and pulmonary vascular resistance indices, and persistent oxygen desaturation despite improving ventricular contractility documented both cardiac and pulmonary injury. After treatment with dobutamine and milrinone all manifestations resolved.
Collapse
Affiliation(s)
- Ives de Chazal
- Division of Critical Care and Division of Critical Care Neurology, Mayo Medical Center, Saint Marys Hospital, Rochester, Minnesota
| | | | | | | |
Collapse
|
15
|
Suzuki K, Osada N, Akasi YJ, Suzuki N, Sakakibara M, Miyake F, Maki F, Takahashi Y. An atypical case of "Takotsubo cardiomyopathy" during alcohol withdrawal: abnormality in the transient left ventricular wall motion and a remarkable elevation in the ST segment. Intern Med 2004; 43:300-5. [PMID: 15168772 DOI: 10.2169/internalmedicine.43.300] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
A 64-year-old man was admitted due to hypokalemia-related myopathy. He was heavy drinker. He felt the stress of alcohol withdrawal during his hospitalization. The patient suffered a cardiopulmonary arrest lasting approximately 5 minutes on the fifth hospital day. One day later, ST-segment elevation was observed in leads I, aV(L), and V(2-6). Emergent cardiac catheterization was performed for suspicion of acute myocardial infarction. Normal coronary arteries with anterior akinesis of the left ventricle were revealed during the procedure. The present case may be an atypical form of "Takotsubo cardiomyopathy" in which the left ventricular contraction is due to focal anterior wall motion abnormalities.
Collapse
Affiliation(s)
- Kengo Suzuki
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki
| | | | | | | | | | | | | | | |
Collapse
|
16
|
Sakr YL, Ghosn I, Vincent JL. Cardiac manifestations after subarachnoid hemorrhage: a systematic review of the literature. Prog Cardiovasc Dis 2002; 45:67-80. [PMID: 12138415 DOI: 10.1053/pcad.2002.124633] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Cardiac alterations associated with subarachnoid hemorrhage (SAH) have been recognized and frequently reported. We systematically reviewed the literature on MEDLINE using the key words: SAH + (heart, cardiac, electrocardiogram, cardiac enzymes, troponin, myoglobin, echocardiography, scintigraphy, Holter, and regional wall motion abnormalities) and included all articles describing cardiac abnormalities in the course of SAH whether spontaneous or secondary. The diagnosis of SAH was established by computed tomography scan, lumbar puncture, or brain autopsy. Cardiac abnormalities were identified by electrocardiogram, enzymatic elevation, Holter monitoring, echocardiography, cardiac scintigraphy, coronary angiography, or autopsy. Despite the considerable literature describing cardiac alterations during the course of SAH, epidemiological, pathophysiological, and prognostic aspects are yet to be clarified. Further studies are needed to evaluate the magnitude of this problem.
Collapse
Affiliation(s)
- Yasser L Sakr
- Department of Intensive Care, Erasme Hospital, Free University of Brussels, Belgium
| | | | | |
Collapse
|
17
|
Masuda T, Sato K, Yamamoto SI, Matsuyama N, Shimohama T, Matsunaga A, Obuchi S, Shiba Y, Shimizu S, Izumi T. Sympathetic nervous activity and myocardial damage immediately after subarachnoid hemorrhage in a unique animal model. Stroke 2002; 33:1671-6. [PMID: 12053010 DOI: 10.1161/01.str.0000016327.74392.02] [Citation(s) in RCA: 151] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Obvious cardiac dysfunction, including ECG abnormalities and left ventricular asynergy, is known to develop after subarachnoid hemorrhage (SAH). To clarify the close relationship between myocardial damage and sympathetic nervous activity immediately after SAH, a novel experimental animal model was used. METHODS SAH was provoked by perforation of the basilar artery with the use of a microcatheter inserted through the femoral artery in 18 beagle dogs. Hemodynamic changes were recorded, and plasma concentrations of noradrenaline, adrenaline, and 3-methoxy-4-hydroxy-phenylethylene glycol (MHPG) and serum levels of creatine kinase-MB (CK-MB) and troponin T were measured at 0, 5, 15, 30, 60, 120, and 180 minutes after SAH. RESULTS Noradrenaline (pg/mL), adrenaline (pg/mL), and MHPG (ng/mL) increased abruptly from 120+/-70, 130+/-70, and 1.3+/-0.5 before SAH to 1700+/-1200, 5600+/-3500, and 3.2+/-1.2 at 5 minutes after SAH, respectively. Aortic pressure, left ventricular wall motion, and cardiac output increased by 60%, 40%, and 30%, respectively (P<0.001) at 5 minutes and then decreased by 50%, 55%, and 40%, respectively (P<0.001) >60 minutes after SAH compared with baseline values. The peak value of CK-MB correlated positively with the peak values of noradrenaline and adrenaline (r=0.730 and r=0.611, respectively). The peak value of troponin T also correlated positively with the peak values of noradrenaline and adrenaline (r=0.828 and r=0.792, respectively). CONCLUSIONS These results suggest that the elevated activity of the sympathetic nervous system observed in the acute phase of SAH induced myocardial damage and contributed to the development of cardiac dysfunction.
Collapse
Affiliation(s)
- Takashi Masuda
- Department of Rehabilitation, School of Medicine, Kitasato University, Sagamihara, Japan.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Owa M, Aizawa K, Urasawa N, Ichinose H, Yamamoto K, Karasawa K, Kagoshima M, Koyama J, Ikeda S. Emotional stress-induced 'ampulla cardiomyopathy': discrepancy between the metabolic and sympathetic innervation imaging performed during the recovery course. JAPANESE CIRCULATION JOURNAL 2001; 65:349-52. [PMID: 11316138 DOI: 10.1253/jcj.65.349] [Citation(s) in RCA: 108] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Four patients had the clinical features of 'ampulla cardiomyopathy', consisting of acute-onset transient left ventricular apical akinesis with basal normokinesis, normal coronary angiogram, ST-segment elevation and subsequent giant T wave inversion, which mimicked acute coronary syndrome, the onset of which occurred shortly after extreme mental stress. Myocardial necrosis was minimal, although 2 patients showed elevated serum catecholamine levels in the acute phase. Each patient underwent serial cardiac radionuclide single-photon emission computed tomography of myocardial functional sympathetic innervation, fatty acid metabolism and perfusion using I-123-metaiodobenzyl-guanidine (MIBG), I-123-beta-metyl-iodophenyl pentadecanoic acid (BMIPP) and thallium-201 (201Tl), respectively. In the acute phase, MIBG and BMIPP imaging showed an uptake defect in the apical region, whereas 201Tl uptake was mildly decreased. When assessed semi-quantitatively, the MIBG images had higher defect scores from the acute phase throughout the year of observation compared with BMIPP, and 201Tl. These observations suggest that the primary cause of ampulla cardiomyopathy is related to a disturbance of the cardiac sympathetic innervation.
Collapse
Affiliation(s)
- M Owa
- Third Department of Internal Medicine, Shinshu University School of Medicine, Nagano, Japan.
| | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Mayer SA, Lin J, Homma S, Solomon RA, Lennihan L, Sherman D, Fink ME, Beckford A, Klebanoff LM. Myocardial injury and left ventricular performance after subarachnoid hemorrhage. Stroke 1999; 30:780-6. [PMID: 10187879 DOI: 10.1161/01.str.30.4.780] [Citation(s) in RCA: 223] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND PURPOSE Electrocardiographic abnormalities and elevations of the creatine kinase myocardial isoenzyme (CK-MB) occur frequently after subarachnoid hemorrhage. In some patients, a reversible and presumably neurogenic form of left ventricular dysfunction is demonstrated by echocardiography. It is not known whether cardiac injury of this type adversely affects cardiovascular hemodynamic performance. METHODS We retrospectively studied 72 patients admitted to our neuro-ICU for aneurysmal subarachnoid hemorrhage over a 2.5-year period. We selected patients who met the following criteria: (1) CK-MB levels measured within 3 days of onset, (2) pulmonary artery catheter placed, (3) echocardiogram performed, and (4) no history of preexisting cardiac disease. Hemodynamic profiles were recorded on the day after surgery (n=67) or on the day of echocardiography (n=5) if surgery was not performed (mean, 3. 3+/-1.7 days after onset). The severity of cardiac injury was classified as none (peak CK-MB <1%, n=36), mild (peak CK-MB 1% to 2%, n=21), moderate (peak CK-MB >2%, n=6), or severe (abnormal left ventricular wall motion, n=9). RESULTS Abnormal left ventricular wall motion occurred exclusively in patients with peak CK-MB levels >2% (P<0.0001), poor neurological grade (P=0.002), and female sex (P=0.02). Left ventricular stroke volume index and stroke work index were elevated above the normal range in patients with peak CK-MB levels <1% and fell progressively as the severity of cardiac injury increased, with mean values for patients with abnormal wall motion below normal (both P<0.0001 by ANOVA). Cardiac index followed a similar trend, but the effect was less pronounced (P<0.0001). Using forward stepwise multiple logistic regression, we found that thick subarachnoid clot on the admission CT scan (odds ratio, 1.9; 95% confidence interval [95% CI], 1.0 to 3.4; P=0.04) and depressed cardiac index (odds ratio, 2.1; 95% CI, 1.0 to 4.1; P=0.04) were independent predictors of symptomatic vasospasm. CONCLUSIONS Myocardial enzyme release and echocardiographic wall motion abnormalities are associated with impaired left ventricular performance after subarachnoid hemorrhage. In severely affected patients, reduction of cardiac output from normally elevated levels may increase the risk of cerebral ischemia related to vasospasm.
Collapse
Affiliation(s)
- S A Mayer
- Department of Neurology, Columbia-Presbyterian Medical Center, New York, NY, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Pinto RJ, Goyal V, Sharma S, Bhagwati SN. Transient myocardial dysfunction in a patient with subarachnoid haemorrhage. Int J Cardiol 1994; 46:289-91. [PMID: 7814185 DOI: 10.1016/0167-5273(94)90254-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
We report a patient of subarachnoid haemorrhage who presented with severe left ventricular dysfunction and marked electrocardiographic changes indistinguishable from acute myocardial infarction. Coronary arteriography showed normal anatomy and the ventricular regional wall motion abnormalities recovered spontaneously after 3 weeks. The implications of this association are discussed.
Collapse
Affiliation(s)
- R J Pinto
- Department of Cardiology, Bombay Hospital, India
| | | | | | | |
Collapse
|