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Published on: August 30, 2020
Acute Subarachnoid Hemorrhage and Cardiac Abnormalities: Takotsubo Cardiomyopathy or Neurogenic Stunned Myocardium? a
1Department of Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan,48201, USA. drcarlosfranco@yahoo.com.
Insights
Subarachnoid hemorrhage can cause Takotsubo cardiomyopathy, a reversible heart condition. This case report highlights the diagnosis and recovery of a patient with subarachnoid hemorrhage-induced Takotsubo cardiomyopathy.
Area of Science:
- Cardiology
- Neurology
Background:
- Cardiac abnormalities are a known complication of subarachnoid hemorrhage.
- Takotsubo cardiomyopathy (TC), or transient left ventricular apical ballooning cardiomyopathy, has been rarely reported in patients with subarachnoid hemorrhage.
Purpose of the Study:
- To present a case of Takotsubo cardiomyopathy following subarachnoid hemorrhage.
- To emphasize the diagnostic criteria and clinical course of this condition.
Main Methods:
- A case of an adult female with somnolence after a ruptured basilar aneurysm is presented.
- Diagnostic workup included ECG, transthoracic echocardiogram, and myocardial contrast echocardiography.
- The patient received medical management and follow-up imaging was performed.
Main Results:
- The patient developed acute heart failure with elevated Troponin-I and ECG changes consistent with TC.
- Echocardiography revealed severe systolic dysfunction and apical akinesis.
- Myocardial contrast echocardiography showed impaired capillary blood flow in affected segments, which normalized with treatment.
Conclusions:
- This case supports the diagnosis of Takotsubo cardiomyopathy in patients with subarachnoid hemorrhage.
- Clinical and imaging findings are crucial for diagnosing this syndrome.
Introduction:
Cardiac abnormalities can be seen with subarachnoid hemorrhage. To date, there have been isolated case reports of transient left ventricular apical ballooning cardiomyopathy, also known as Takotsubo cardiomyopathy in patients suffering from subarachnoid hemorrhage.
Case Presentation:
An adult female was brought to the emergency department with somnolence. A 3 x 3 mm ruptured basilar aneurysm was found and successfully embolized. Two days after the patient developed acute heart failure. Troponin-I was elevated to 4.2 (normal <0.4). On ECG, new symmetric T wave inversion in V3, V4, V5 with prolonged QT were evident. Transthoracic echocardiogram showed severe systolic dysfunction with an ejection fraction of 20% and akinetic apex along with the distal left ventricular segments, consistent with Takotsubo cardiomyopathy. Myocardial contrast echocardiography showed a decrease in capillary blood flow and volume in the akinetic areas with delayed contrast replenishment, sparing the basal segments. A repeat study 2 weeks later showed near normalization of the perfusion parameters. The patient improved with medical management. A repeat echocardiogram, a month later revealed an ejection fraction of 45% with no identifiable wall motion abnormality.
Conclusion:
Our case, as well as others reported previously, supports the diagnosis of Takotsubo cardiomyopathy in patients with Subarachnoid Hemorrhage who fulfill the clinical and imaging description of this syndrome.
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