Myocardial dysfunction after subarachnoid haemorrhage and tako-tsubo cardiomyopathy: a differential diagnosis?

The frequent occurrence of a reversible left ventricular dysfunction complicating subarachnoid haemorrhage raises a number of issues about the clinical and pathophysiological similarities with the transient left ventricular apical ballooning syndrome (TLVABS) or tako-tsubo cardiomyopathy (TTC). Given the latest clinical and pathophysiological evidence about neurogenic cardiomyopathies, the diagnosis of TTC should not be ruled out in patients experiencing acute brain injury and cerebrovascular events. Each type of reversible left ventricular dysfunction mediated by the central nervous system and initiated by acute brain injury, both physical, such as intracranial bleeding or head traumas, and psychological, such as sudden emotional stress, could be encompassed in a single definition with larger inclusion criteria, such as 'acute ballooning cardiomyopathy' (ABC), that is likely to be more representative of the real needs in the clinical setting.