1
|
Vazirani R, Rodríguez-González M, Castellano-Martinez A, Andrés M, Uribarri A, Corbí-Pascual M, Alfonso F, Blanco-Ponce E, Lluch-Requerey C, Fernández-Cordón C, Almendro-Delia M, Cruz OV, Núñez-Gil IJ. Pediatric takotsubo cardiomyopathy: A review and insights from a National Multicentric Registry. Heart Fail Rev 2024; 29:739-750. [PMID: 38483658 DOI: 10.1007/s10741-024-10394-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/13/2024] [Indexed: 04/09/2024]
Abstract
Takotsubo syndrome (TTS) in the pediatric population is an infrequent but relevant cause of morbidity and mortality, with limited studies addressing its clinical course and prognosis. We aimed to analyze the clinical features and prognosis of pediatric TTS in a nation-wide multicenter registry and considering the published literature. We included a total of 54 patients from 4 different hospitals in Spain, as well as pediatric TTS patients from the published literature. Comparisons between groups were performed in order to assess for statistically and clinically relevant prognostic differences between pediatric and adult population features. Patients with pediatric TTS are more commonly male and exhibit a higher prevalence of physical triggers. The left ventricular ejection fraction (LVEF) was significantly lower in the pediatric population (30.5 + 10.4 vs 36.9 + 16.9, p < 0.05), resulting in more than fivefold rates of cardiogenic shock on admission compared to the general adult TTS population (Killip IV 74.1% vs 10.5%, p < 0.001) with similar rates of death and recurrence between groups. TTS in the pediatric population presents a distinctive clinical profile, with higher prevalence of atypical symptoms and physical triggers, as well as higher rates of cardiogenic shock on admission and similar mortality and recurrence rates than those of the adult population. This study provides valuable insights into understanding pediatric TTS and underscores the necessity for further research in this age group.
Collapse
Affiliation(s)
- Ravi Vazirani
- Department of Cardiology, Hospital Clínico San Carlos, Madrid, Spain
| | | | | | - Mireia Andrés
- Department of Cardiology, Hospital Universitari Vall d´Hebron. VHIR - Vall d´Hebron Institut de Recerca. CIBERCV, Barcelona, Spain
| | - Aitor Uribarri
- Department of Cardiology, Hospital Universitari Vall d´Hebron. VHIR - Vall d´Hebron Institut de Recerca. CIBERCV, Barcelona, Spain
| | | | - Fernando Alfonso
- Department of Cardiology, Hospital Universitario de La Princesa, IIS-IP, CIBERCV, Universidad Autónoma de Madrid, Madrid, Spain
| | - Emilia Blanco-Ponce
- Department of Cardiology, Hospital Universitario Arnau de Vilanova, IRB LLeida, Lleida, Spain
| | | | | | - Manuel Almendro-Delia
- Department of Cardiology, Hospital Universitario Virgen de la Macarena, Seville, Spain
| | - Oscar Vedia Cruz
- Department of Cardiology, Hospital Clínico San Carlos, Madrid, Spain
| | - Iván J Núñez-Gil
- Department of Cardiology, Hospital Clínico San Carlos, Madrid, Spain.
- Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain.
| |
Collapse
|
2
|
Barnicle R, Bracey A, Rosser A, Gordon D. Acute Obstructive Hydrocephalus: An Unexpected Cause of Cardiac Arrest. J Emerg Med 2024; 66:139-143. [PMID: 38228458 DOI: 10.1016/j.jemermed.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 05/21/2023] [Accepted: 07/15/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND Emergency physicians are well-versed in managing cardiac arrests, including the diagnostic and therapeutic steps after return of spontaneous circulation. Neurologic emergencies are a common cause of out-of-hospital cardiac arrest and must remain high in the differential diagnosis, as such cases often require specific interventions that may deviate from more common care pathways. Performing a noncontrast head computed tomography (NCHCT) scan after cardiac arrest has been found to change management, although the optimal timing of this imaging is unclear. CASE REPORT This is the case of a young, pregnant woman who presented to the emergency department after cardiac arrest with return of spontaneous circulation in the prehospital setting. She was found to have acute obstructive hydrocephalus on NCHCT, which was later confirmed to be due to a previously undiagnosed colloid cyst of the third ventricle. This acute obstruction resulted in myocardial stunning and, ultimately, cardiac arrest. Although outcomes are often dismal when the cause of arrest is secondary to neurologic catastrophe, this patient survived with completely intact neurologic function. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Although acute obstructive hydrocephalus due to a colloid cyst adjacent to the third ventricle is a rare condition, it is a potentially reversible neurologic cause of out-of-hospital cardiac arrest. However, positive outcomes depend on obtaining the diagnosis rapidly with neurologic imaging and advocating for neurosurgical intervention. This case supports the recommendation that emergency physicians should strongly consider post-cardiac arrest neurologic imaging when another cause is not immediately obvious.
Collapse
Affiliation(s)
- Ryan Barnicle
- Department of Emergency Medicine, Brown Emergency Medicine, Providence, Rhode Island
| | - Alexander Bracey
- Department of Emergency Medicine, Albany Medical Center, Albany, New York
| | - Alison Rosser
- Department of Emergency Medicine, Atrium Health Carolinas Medical Center, Charlotte, North Carolina
| | - David Gordon
- Department of Surgical Critical Care, MedStar Health, Washington, District of Columbia
| |
Collapse
|
3
|
Sundaram M, Mishra RK, Uppar AM. Neurogenic stunned myocardium resulting from surgical brainstem handling during resection of paediatric recurrent medulloblastoma-a possible brain heart interaction. Childs Nerv Syst 2022; 38:2025-2028. [PMID: 35460357 DOI: 10.1007/s00381-022-05523-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 04/10/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Neurogenic stunned myocardium (NSM) is characterised by an acute onset cardiac dysfunction following an acute neurological insult which mimics acute coronary syndrome. CASE DETAILS A 12-year-old male child was admitted to the neuro-intensive care unit (NICU) following midline suboccipital craniotomy and resection of recurrent medulloblastoma. Postoperatively, in NICU, he developed tachycardia and hypotension, which was unresponsive to fluid challenge requiring norepinephrine infusion. Intraoperatively, during tumour resection from the dorsal medulla, episodes of hypertension and bradycardia were observed. Intraoperative blood loss was adequately managed with a stable hemodynamic profile without postoperative anaemia. An electrocardiogram showed sinus tachycardia with T wave inversion, and blood investigation revealed elevated cardiac troponin T levels. Point of care ultrasound (POCUS) of heart and lung showed features of NSM. Infusion dobutamine was added to achieve a target mean arterial pressure of 65 mm Hg with concomitant furosemide infusion and fluid restriction. Daily POCUS assessment of cardiac contractility and volume status was done. The patient was weaned from vasoactive drugs and ventilator following improvement of cardiac function and was discharged from NICU after 17 days. CONCLUSION NSM results from the excessive release of catecholamines following stimulation of trigger zones in the brain. To date, a handful of cases of pediatric NSM following primary brain tumour are reported where hydrocephalus resulted in trigger zone activation. In this presented case, direct brain stem stimulation during tumour resection might have triggered NSM. Irrespective of the cause, timely diagnosis and execution of supportive management in our patient resulted in a positive outcome.
Collapse
Affiliation(s)
- Mouleeswaran Sundaram
- Department of Neuroanaesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.
| | - Rajeeb Kumar Mishra
- Department of Neuroanaesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Alok Mohan Uppar
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| |
Collapse
|
4
|
Ramos-Rodriguez A, Fernandez-Bravo C, Estepa-Pedregosa L, Rodriguez-Gonzalez M. The Pivotal Role of Echocardiography in the Diagnosis of Stress-Induced Cardiomyopathy Presenting with a Typical Pattern in Critically Ill Children. An Illustrative Case Report. Curr Med Imaging 2022; 18:1003-1011. [PMID: 35170419 DOI: 10.2174/1573405618666220216121424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 11/03/2021] [Accepted: 11/04/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Takotsubo cardiomyopathy (TCM) has some distinctive features like greater proportion of reverse-TCM and disease of central nervous system as a prevalent triggering cause. We expose the case of a child with cardiogenic shock presenting an atypical echocardiographic TCM pattern on echocardiography, after an acute neurologic trigger. We also include a systematic review of the literature of previously described cases of atypical-TCM in children. CASE REPORT A previously healthy 9 year-old boy with status epilepticus who presented abrupt cardiogenic shock. The EKG showed signs of myocardial ischemia, cardiac biomarkers NT-proBNP (2756 pg/mL ) and Troponin I (1707 pg/mL ) were raised, and echocardiography exposed a dilated LV with severely reduced systolic function (LVEF 28%) along with hypokinetic mid-basal segments (circumferential ballooning) and preserved hypercontractile apical segments, with normal origin of both coronary arterial systems. A presumptive diagnosis of "reverse", "inverse" or atypical Takotsubo cardiomyopathy was build based on the echocardiographic findings, apart from the ACS-like EKG findings, the raised cardiac biomarkers and the neurological trigger of the hypercatecholaminergic state. Despite cardiovascular improvement with supportive treatment, the patient eventually expired on day 2 after PICU admission due to neurological complications. As shown in our systematic review, only 19 similar cases have been reported to date. CONCLUSION With the report of this unusual case, we aim to point out the fundamental role of bedside echocardiography as diagnostic test for critically ill children presenting with ACS-like in the context of neurosurgical emergencies, where bedside echocardiography itself can accurately establish a presumptive diagnosis of TCM.
Collapse
|
5
|
Pediatric takotsubo syndrome caused by hydrocephalus after posterior fossa tumor surgery. Childs Nerv Syst 2021; 37:3957-3961. [PMID: 33619591 DOI: 10.1007/s00381-021-05090-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 02/09/2021] [Indexed: 10/22/2022]
Abstract
Takotsubo syndrome (TTS) can develop after intense physical or emotional stress and is uncommon in children. We report a 2-year-old girl who developed TTS caused by acute hydrocephalus after posterior fossa tumor resection and required mechanical ventilation and administration of vasopressor/inotropic agents. Her cardiac function gradually recovered over the course of 2 weeks. Hydrocephalus after posterior fossa surgery can cause compression of the medulla oblongata, resulting in solitary nucleus dysfunction and TTS, a potentially life-threatening complication.
Collapse
|
6
|
Ayasa M, Shaikh N, Marcus MAE. A 3rd ventricular colloid cyst causing acute hydrocephalus with stunned myocardium: A case report. Qatar Med J 2020; 2020:28. [PMID: 33282712 PMCID: PMC7684555 DOI: 10.5339/qmj.2020.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 05/17/2020] [Indexed: 12/05/2022] Open
Abstract
Background: Third ventricular colloid cysts are benign but may cause acute hydrocephalus, raised intracranial pressure, decreased consciousness level, and sudden death. These ventricular colloid cysts associated with stunned myocardium are rarely reported in the literature. This study reported a case of a third ventricular colloid cyst presented as acute hydrocephalus complicated with severe neurogenic pulmonary edema, stunned myocardium, and heart failure, which survived at the end. Case presentation: A 29-year-old woman presented to the emergency department with one day history of headache, vomiting, and altered consciousness level. Early brain imaging showed a cyst in the third ventricle. The patient rapidly deteriorated neurologically and developed severe pulmonary edema and heart failure requiring immediate external ventricular drain and heart failure management. Once stabilized, she underwent endoscopic excision of the ventricular cyst. Histopathology confirmed the diagnosis of colloidal cyst. She survived all these acute life-threatening events, improved, and stabilized, and was discharged home. She was followed up in outpatient clinics after 6 months of discharge with no symptoms or neurological deficit. Conclusion: A third ventricular colloid cyst can cause acute hydrocephalus leading to stunned myocardium requiring immediate surgical intervention, advanced hemodynamic monitoring, and acute heart failure management.
Collapse
Affiliation(s)
- Mohammed Ayasa
- Department of Anesthesia, SICU & Perioperative Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Nissar Shaikh
- Department of Anesthesia, SICU & Perioperative Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Marco A E Marcus
- Department of Anesthesia, SICU & Perioperative Medicine, Hamad Medical Corporation, Doha, Qatar
| |
Collapse
|
7
|
Díaz Ruiz L, Durán Lorenzo I, Ordoñez Sáez O. Neurogenic Stunned Myocardium in Two Children with Neurological Injury. J Pediatr Intensive Care 2019; 8:238-241. [PMID: 31673460 DOI: 10.1055/s-0039-1693032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 05/28/2019] [Indexed: 10/26/2022] Open
Abstract
Neurogenic stunned myocardium is described as sudden and reversible cardiac dysfunction induced by an acute neurological event. This phenomenon has not been thoroughly investigated in infants, and is probably underdiagnosed. Here, we report the cases of two infants with neurogenic stunned myocardium in whom the clinical suspicion was relevant, with a brief discussion of this condition.
Collapse
Affiliation(s)
- Laura Díaz Ruiz
- Department of Pediatrics, Pediatric Intensive Care Unit, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Iria Durán Lorenzo
- Department of Pediatrics, Pediatric Intensive Care Unit, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Olga Ordoñez Sáez
- Department of Pediatrics, Pediatric Intensive Care Unit, Hospital Universitario 12 de Octubre, Madrid, Spain
| |
Collapse
|
8
|
Crevier-Sorbo G, Atkinson J, Di Genova T, Puligandla P, Dudley RWR. Hydrocephalus-induced neurogenic stunned myocardium and cardiac arrest in a child: completely reversed with CSF diversion. J Neurosurg Pediatr 2019; 24:35-40. [PMID: 31003226 DOI: 10.3171/2019.2.peds18711] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 02/28/2019] [Indexed: 01/11/2023]
Abstract
Neurogenic stunned myocardium (NSM) is a potentially fatal cause of sudden cardiogenic dysfunction due to an acute neurological event, most commonly aneurysmal subarachnoid hemorrhage in adults. Only two pediatric cases of hydrocephalus-induced NSM have been reported. Here the authors report a third case in a 14-year-old boy who presented with severe headache, decreased level of consciousness, and shock in the context of acute hydrocephalus secondary to fourth ventricular outlet obstruction 3 years after standard-risk medulloblastoma treatment. He was initially stabilized with the insertion of an external ventricular drain and vasopressor treatment. He had a profoundly reduced cardiac contractility and became asystolic for 1 minute, requiring cardiopulmonary resuscitation when vasopressors were inadvertently discontinued. Over 1 week, his ventricles decreased in size and his cardiac function returned to normal. All other causes of heart failure were ruled out, and his impressive response to CSF diversion clarified the diagnosis of NSM secondary to hydrocephalus. He was unable to be weaned from his drain during his time in the hospital, so he underwent an endoscopic third ventriculostomy and has remained well with normal cardiac function at more than 6 months' follow-up. This case highlights the importance of prompt CSF diversion and cardiac support for acute hydrocephalus presenting with heart failure in the pediatric population.
Collapse
|
9
|
Ripoll JG, Blackshear JL, Díaz-Gómez JL. Acute Cardiac Complications in Critical Brain Disease. Neurosurg Clin N Am 2018; 29:281-297. [PMID: 29502718 DOI: 10.1016/j.nec.2017.11.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Acute cardiac complications in critical brain disease should be understood as a clinical condition representing an intense brain-heart crosstalk and might mimic ischemic heart disease. Two main entities (neurogenic stunned myocardium [NSM] and stress cardiomyopathy) have been better characterized in the neurocritically ill patients and they portend worse clinical outcomes in these cases. The pathophysiology of NSM remains elusive. However, significant progress has been made on the early identification of neurocardiac compromise following acute critical brain disease. Effective prevention and treatment interventions are yet to be determined.
Collapse
Affiliation(s)
- Juan G Ripoll
- Department of Critical Care Medicine, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - Joseph L Blackshear
- Department of Cardiology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - José L Díaz-Gómez
- Departments of Critical Care Medicine, Anesthesiology and Neurologic Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA.
| |
Collapse
|
10
|
Ripoll JG, Blackshear JL, Díaz-Gómez JL. Acute Cardiac Complications in Critical Brain Disease. Neurol Clin 2018; 35:761-783. [PMID: 28962813 DOI: 10.1016/j.ncl.2017.06.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Acute cardiac complications in critical brain disease should be understood as a clinical condition representing an intense brain-heart crosstalk and might mimic ischemic heart disease. Two main entities (neurogenic stunned myocardium [NSM] and stress cardiomyopathy) have been better characterized in the neurocritically ill patients and they portend worse clinical outcomes in these cases. The pathophysiology of NSM remains elusive. However, significant progress has been made on the early identification of neurocardiac compromise following acute critical brain disease. Effective prevention and treatment interventions are yet to be determined.
Collapse
Affiliation(s)
- Juan G Ripoll
- Department of Critical Care Medicine, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - Joseph L Blackshear
- Department of Cardiology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - José L Díaz-Gómez
- Departments of Critical Care Medicine, Anesthesiology and Neurologic Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA.
| |
Collapse
|
11
|
Application of transpulmonary thermodilution monitoring (PiCCO) in patient with neurogenic pulmonary edema and acute obstructive hydrocephalus due to a central neurocytoma: A case report. INTERDISCIPLINARY NEUROSURGERY 2017. [DOI: 10.1016/j.inat.2017.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
12
|
Urbinati A, Pellicori P, Guerra F, Capucci A, Clark AL. Takotsubo syndrome in the paediatric population. J Cardiovasc Med (Hagerstown) 2017; 18:262-267. [DOI: 10.2459/jcm.0000000000000446] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
|
13
|
Stunned myocardium after an anesthetic procedure in a pediatric patient – case report. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2016. [DOI: 10.1016/j.repce.2015.09.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
14
|
Faleiro Oliveira J, Rebelo Pacheco S, Moniz M, Nunes P, Abadesso C, Rebelo M, Loureiro H, Almeida H. Stunned myocardium after an anesthetic procedure in a pediatric patient - case report. Rev Port Cardiol 2016; 35:375.e1-5. [PMID: 27179636 DOI: 10.1016/j.repc.2015.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Accepted: 09/13/2015] [Indexed: 11/27/2022] Open
Abstract
Takotsubo syndrome (TTS) is an acquired transient type of systolic dysfunction which mimics myocardial infarction clinically and electrocardiographically. TTS is also known as stress cardiomyopathy, broken heart syndrome, apical ballooning, reversible acute heart failure, neurogenic stunned myocardium or acute catecholamine cardiomyopathy. This case report describes an uncommon presentation of myocardial stunning after an anesthetic procedure. A 14-year-old girl with a history of pineal cyst and hemiplegic migraine was admitted for control brain magnetic resonance imaging. During anesthesia induction with propofol she suffered bradycardia, which was reversed with atropine, followed by tachyarrhythmia, reversed with lidocaine and precordial thump. Within hours she developed pulmonary edema and global respiratory failure due to acute left ventricular dysfunction. A transthoracic echocardiogram showed a dilated left ventricle with global hypokinesia and depressed left ventricular systolic function (ejection fraction <30%). The electrocardiogram showed persistent sinus tachycardia and nonspecific ST-T wave abnormalities. Cardiac biomarkers were elevated (troponin 2.42 ng/ml, proBNP 8248 pg/ml). She was placed on diuretics, angiotensin-converting enzyme inhibitors, digoxin and dopamine. The clinical course was satisfactory with clinical, biochemical and echocardiographic improvement within four days. Subsequent echocardiograms showed no ventricular dysfunction. The patient was discharged home on carvedilol, which was discontinued after normalization of cardiac function on cardiac magnetic resonance imaging. Few cases of TTS have been described in children, some of them triggered by acute central nervous system disorders and others not fulfilling all the classical diagnostic criteria. In this case the anesthetic procedure probably triggered the TTS.
Collapse
Affiliation(s)
| | - Susana Rebelo Pacheco
- Departamento de Pediatria, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
| | - Marta Moniz
- Unidade de Cuidados Intensivos e Especiais Pediátricos, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
| | - Pedro Nunes
- Unidade de Cuidados Intensivos e Especiais Pediátricos, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
| | - Clara Abadesso
- Unidade de Cuidados Intensivos e Especiais Pediátricos, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
| | - Mónica Rebelo
- Unidade de Cardiologia Pediátrica, Departamento de Pediatria do Hospital de Santa Maria, CHLN, Lisboa , Portugal
| | - Helena Loureiro
- Unidade de Cuidados Intensivos e Especiais Pediátricos, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
| | - Helena Almeida
- Unidade de Cuidados Intensivos e Especiais Pediátricos, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
| |
Collapse
|
15
|
Lopez Chiriboga AS, Yoon JW, Freeman WD, Odunukan OW, Cheshire WP. Takotsubo cardiomyopathy in the setting of acute hydrocephalus secondary to neurocysticercosis. Clin Auton Res 2016; 26:235-41. [PMID: 26951133 DOI: 10.1007/s10286-016-0348-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 02/02/2016] [Indexed: 01/21/2023]
Abstract
We report the case of a 45-year-old male who presented with transient neurogenic stunned myocardium, or takotsubo cardiomyopathy, secondary to acute hydrocephalus caused by obstruction of the third ventricle by neurocysticercosis.
Collapse
Affiliation(s)
- A S Lopez Chiriboga
- Department of Neurology, Mayo Clinic, 4500 San Pablo Rd., Jacksonville, FL, 32224, USA.
| | - J W Yoon
- Department of Neurosurgery, Mayo Clinic, 4500 San Pablo Rd., Jacksonville, FL, 32224, USA
| | - W D Freeman
- Department of Neurology, Mayo Clinic, 4500 San Pablo Rd., Jacksonville, FL, 32224, USA
| | - O W Odunukan
- Department of Cardiology, Mayo Clinic, 4500 San Pablo Rd., Jacksonville, FL, 32224, USA
| | - W P Cheshire
- Department of Neurology, Mayo Clinic, 4500 San Pablo Rd., Jacksonville, FL, 32224, USA
| |
Collapse
|
16
|
Moriya S, Inamasu J, Oheda M, Hirose Y. Neurogenic stunned myocardium associated with pediatric brain tumor may not be catecholamine-induced. Ann Pediatr Cardiol 2015; 8:240-2. [PMID: 26556973 PMCID: PMC4608204 DOI: 10.4103/0974-2069.164689] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A rare case of pediatric neurogenic stunned myocardium (NSM) associated with a brain tumor is reported. A previously healthy 6-year-old boy presented with coma, and imaging studies revealed a brain tumor. On hospitalization day 3, he developed NSM and neurogenic pulmonary edema necessitating intensive cardiopulmonary support. Although blood marker levels of cardiac injury were elevated, his plasma and urinary norepinephrine levels were within normal limits. His cardiorespiratory functions markedly improved by hospitalization day 8. This case report may be one of the first to document plasma and urinary catecholamine levels in pediatric NSM. While solid conclusion cannot be drawn based on experience from a single case, these results suggest that pediatric NSM may not be catecholamine-induced.
Collapse
Affiliation(s)
- Shigeta Moriya
- Department of Neurosurgery, Fujita Health University Hospital, Toyoake, Japan
| | - Joji Inamasu
- Department of Neurosurgery, Fujita Health University Hospital, Toyoake, Japan
| | - Motoki Oheda
- Department of Neurosurgery, Fujita Health University Hospital, Toyoake, Japan
| | - Yuichi Hirose
- Department of Neurosurgery, Fujita Health University Hospital, Toyoake, Japan
| |
Collapse
|
17
|
Piña Batista K, Gutiérrez Morales J, Astudillo A, Alvarez de Eulate-Beramendi S. Fulminant stunned myocardium following endoscopic ventriculostomy in a patient with chronic hydrocephalus. NEUROLOGÍA (ENGLISH EDITION) 2015. [DOI: 10.1016/j.nrleng.2013.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
18
|
Finsterer J, Stöllberger C. Neurological and non-neurological triggers of Takotsubo syndrome in the pediatric population. Int J Cardiol 2015; 179:345-7. [DOI: 10.1016/j.ijcard.2014.11.080] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 11/06/2014] [Indexed: 01/26/2023]
|
19
|
[Neurogenic stunned myocardium in Pediatrics. A case report]. ACTA ACUST UNITED AC 2014; 62:472-6. [PMID: 25530429 DOI: 10.1016/j.redar.2014.10.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Revised: 10/13/2014] [Accepted: 10/30/2014] [Indexed: 01/10/2023]
Abstract
Neurogenic stunned myocardium is an unusual clinical entity. It mimics an acute coronary syndrome with electrocardiographic abnormalities, cardiac dysfunction and elevated cardiac enzymes with absence of obstructive coronary disease. It may occur after a neurosurgical procedure. A case is presented of neurogenic stunned myocardium occurring in a child after removal of a posterior fossa medulloblastoma. The patient developed nodal tachycardia with hemodynamic impairment. The clinical course was satisfactory due to antiarrhythmic therapy, with biochemical, echocardiographic, and clinical improvement within a week.
Collapse
|
20
|
Cardiac wall motion abnormality after bleeding from vertebral artery aneurysms. Clin Auton Res 2014; 24:259-64. [DOI: 10.1007/s10286-014-0256-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 09/02/2014] [Indexed: 10/24/2022]
|
21
|
Finsterer J, Wahbi K. CNS disease triggering Takotsubo stress cardiomyopathy. Int J Cardiol 2014; 177:322-9. [PMID: 25213573 DOI: 10.1016/j.ijcard.2014.08.101] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 08/17/2014] [Indexed: 01/23/2023]
Abstract
There are a number of hereditary and non-hereditary central nervous system (CNS) disorders, which directly or indirectly affect the heart (brain-heart disorders). The most well-known of these CNS disorders are epilepsy, stroke, infectious or immunological encephalitis/meningitis, migraine, and traumatic brain injury. In addition, a number of hereditary and non-hereditary neurodegenerative disorders may impair cardiac functions. Affection of the heart may manifest not only as arrhythmias, myocardial infarction, autonomic impairment, systolic dysfunction/heart failure, arterial hypertension, or pulmonary hypertension, but also as stress cardiomyopathy (Takotsubo syndrome, TTS). CNS disease triggering TTS includes subarachnoid bleeding, epilepsy, ischemic stroke, intracerebral bleeding, migraine, encephalitis, traumatic brain injury, PRES syndrome, or ALS. Usually, TTS is acutely precipitated by stress triggered by various different events. TTS is one of the cardiac abnormalities most frequently induced by CNS disorders. Appropriate management of TTS from CNS disorders is essential to improve the outcome of affected patients.
Collapse
Affiliation(s)
| | - Karim Wahbi
- Paris-Descartes, Sorbonne Paris Cite University, 75006 Paris, France; AP-HP, Cardiology Department, Cochin Hospital, Paris, France; AP-HP, Neurology Department, Pitié-Salpêtrière Hospital, Paris, France
| |
Collapse
|
22
|
Baleine J, Jacquot A, Novais ARB, Durand S, Milesi C, de la Villéon G, Roujeau T, Cambonie G. Cardiomyopathie de type tako-tsubo chez une adolescente. Arch Pediatr 2014; 21:510-3. [DOI: 10.1016/j.arcped.2014.02.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 10/28/2013] [Accepted: 02/21/2014] [Indexed: 11/26/2022]
|
23
|
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.
Collapse
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
| |
Collapse
|
24
|
Ruggieri F, Cerri M, Beretta L. Infective rhomboencephalitis and inverted Takotsubo: neurogenic-stunned myocardium or myocarditis? Am J Emerg Med 2013; 32:191.e1-3. [PMID: 24079984 DOI: 10.1016/j.ajem.2013.08.047] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 08/22/2013] [Indexed: 12/25/2022] Open
Abstract
Here we originally describe the clinical scenario of a young immune-competent patient affected by acute rhomboencephalitis with severe parenchymal edema and acute hydrocephalus who developed sudden life-threatening cardiac derangement. Hemodynamic and perfusion parameters revealed cardiogenic shock, so intensive circulatory support with epinephrine infusion and intra-aortic balloon pump was needed to restore organ perfusion. Transesophageal echocardiographic examination showed severe left ventricular dysfunction (ejection fraction as low as 20%) with wall motion abnormalities resembling a pattern of Takotsubo-inverted cardiomyopathy. Cultural investigations revealed infection by Listeria monocytogenes. Nevertheless, her conditions rapidly improved, and she had full cardiac recovery within few days. Acute cerebral damage, pattern of echocardiographic wall motion abnormalities, and clinical course may suggest neurogenic stunned as pathological mechanism responsible for cardiac dysfunction, but differential diagnosis with acute myocarditis is to be considered too. Acute cardiogenic shock during the course of rhomboencephalitis by L monocytogenes has not been yet reported; prompt clinical suspicion and intensive care are needed to manage this life-threatening condition.
Collapse
Affiliation(s)
- Francesco Ruggieri
- Anesthesia and Neuro-Intensive Care, Head and Neck Department, San Raffaele Scientific Institute, Milan, Italy.
| | - Marco Cerri
- Anesthesia and Neuro-Intensive Care, Head and Neck Department, San Raffaele Scientific Institute, Milan, Italy
| | - Luigi Beretta
- Anesthesia and Neuro-Intensive Care, Head and Neck Department, San Raffaele Scientific Institute, Milan, Italy
| |
Collapse
|
25
|
Piña Batista KM, Gutiérrez Morales JC, Astudillo A, Alvarez de Eulate-Beramendi S. Fulminant stunned myocardium following endoscopic ventriculostomy in a patient with chronic hydrocephalus. Neurologia 2013; 30:181-3. [PMID: 24011670 DOI: 10.1016/j.nrl.2013.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2013] [Revised: 04/28/2013] [Accepted: 06/06/2013] [Indexed: 11/29/2022] Open
Affiliation(s)
- K M Piña Batista
- Servicio de Neurocirugía, Hospital Universitario Central de Asturias, Oviedo, Asturias, España.
| | - J C Gutiérrez Morales
- Servicio de Neurocirugía, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | - A Astudillo
- Servicio de Neurocirugía, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | | |
Collapse
|
26
|
Neurocardiogenic Pulmonary Oedema: Initial Presentation of Multiple Sclerosis. Heart Lung Circ 2012; 21:853-5. [DOI: 10.1016/j.hlc.2012.06.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Revised: 05/30/2012] [Accepted: 06/03/2012] [Indexed: 11/22/2022]
|
27
|
Neurogenic stunned myocardium after embolization in two children with vein of Galen aneurysmal malformation. Neuroradiology 2012; 55:213-6. [DOI: 10.1007/s00234-012-1088-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2012] [Accepted: 08/27/2012] [Indexed: 10/27/2022]
|
28
|
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
| |
Collapse
|
29
|
Liang CW, Chen R, Macri E, Naval N. Preadmission beta-blockers are associated with decreased incidence of neurogenic stunned myocardium in aneurysmal subarachnoid hemorrhage. J Stroke Cerebrovasc Dis 2011; 22:601-7. [PMID: 22105019 DOI: 10.1016/j.jstrokecerebrovasdis.2011.10.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Revised: 10/03/2011] [Accepted: 10/15/2011] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Neurogenic stunned myocardium (NSM) is a frequent complication of aneurysmal subarachnoid hemorrhage (aSAH), with a significant impact on disease course. The presumed cause is catecholamine surge at the time of aneurysm rupture. Beta-blockers, which reduce the impact of the catecholamine surge, may decrease the risk of developing NSM. METHODS A chart review of 234 consecutive patients admitted to the Oregon Health and Science University Neurosurgery service between March 6, 2008 and June 23, 2010 with a diagnosis of aneurysmal SAH was performed. This group was further subdivided by patients who received echocardiograms on admission, by gender, and by the prehospital administration of β-blockers. RESULTS One hundred thirty of 234 patients had echocardiograms on or shortly after admission, and 18 of these developed NSM (13.8%). None of the 22 patients taking prehospital β-blockers developed NSM. Using the Fisher exact test to compare the 2 groups, patients who were administered prehospital β-blockers were significantly less likely to develop stunning compared to those who were not (P = .04). After correcting for other variables using multiple logistic regression analysis, the previous use of β-blockers was still found to be significantly associated with a decreased incidence of NSM after SAH (P = .049). There was no significant difference in hospital length of stay, peribleed stroke, vasospasm, or death. Of the 18 patients with stunning, 15 were women, 5 of whom were on estrogen supplementation. The mean peak troponin elevation of women who developed NSM on estrogen supplementation was significantly higher than for those who were not (mean peak troponin 9.97 ± 2.01 mg/dL; P < .001). CONCLUSION Prehospital β-blockers are associated with decreased risk of developing NSM in patients with aSAH. Estrogen may play an additional role in shaping the degree of NSM in women.
Collapse
Affiliation(s)
- Conrad W Liang
- Department of Neurology at Oregon Health and Science University, Portland, Oregon, USA.
| | | | | | | |
Collapse
|
30
|
|