Management of catecholamine-induced stunned myocardium--a case report

Area of Science:

• Neurology
• Cardiology
• Critical Care Medicine

Background:

• Cerebral vasospasm is a common complication after subarachnoid hemorrhage.
• Hypertensive, hypervolumic, and hemodilution (Triple-H) therapy is a standard treatment for symptomatic cerebral vasospasm.
• Triple-H therapy can induce a hyperadrenergic state, potentially leading to cardiac dysfunction.

Observation:

• A patient undergoing Triple-H therapy developed cardiac failure.
• Cardiac dysfunction was not apparent when monitoring blood pressure alone.
• Bioreactance noninvasive cardiac output monitoring was utilized for diagnosis.

Findings:

• Continuous cardiac output monitoring identified cardiac failure during Triple-H therapy.
• The patient's cardiac failure was successfully treated with milrinone and dobutamine.
• The patient recovered without neurological deficits.

Implications:

• Relying solely on blood pressure may lead to missed diagnoses of cardiac complications during Triple-H therapy.
• Noninvasive cardiac output monitoring is a valuable tool for guiding therapy in patients receiving Triple-H therapy.
• Early detection and management of cardiac dysfunction can prevent adverse neurological outcomes.