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Acute left ventricular dysfunction and subarachnoid hemorrhage
S G Sakka1, E Huettemann, K Reinhart
1Department of Anesthesiology and Intensive Care Medicine, Friedrich-Schiller University of Jena, FRG.
Journal of Neurosurgical Anesthesiology
|July 22, 1999
Summary
Acute subarachnoid hemorrhage (SAH) can cause severe left ventricular dysfunction, impacting cardiac function. This may require delaying aneurysm surgery until cardiac status improves.
Area of Science:
- Cardiology
- Neurology
- Critical Care Medicine
Background:
- Subarachnoid hemorrhage (SAH) from cerebral aneurysm rupture can precipitate acute cardiac dysfunction.
- Severe left ventricular (LV) dysfunction is a recognized but often underappreciated complication of SAH.
Observation:
- A patient with SAH (Hunt & Hess grade III) presented with profound LV dysfunction (LV ejection fraction ~10%).
- Initial management with fluids and vasopressors failed to improve cardiac index (2.0 L/min/m2).
- Enoximone improved cardiac index (3.9 L/min/m2) and LV ejection fraction (~30%) but was discontinued due to thrombocytopenia.
Findings:
- Severe LV dysfunction in SAH necessitates intensive hemodynamic monitoring and management.
- Aneurysm surgery was postponed for 18 days due to the patient's critical cardiac condition.
- Despite severe cardiac dysfunction, neurological outcomes were not as poor as anticipated.
Implications:
- Early recognition and management of cardiac dysfunction are crucial in SAH patients.
- Cardiac status may dictate the timing of neurosurgical interventions.
- Further research into the pathophysiology and treatment of SAH-induced cardiomyopathy is warranted.