scholarly journals Neurogenic stress cardiomyopathy following aneurysmal subarachnoid haemorrhage: a literature review

2019 ◽  
Vol 25 (1) ◽  
pp. 44-52
Author(s):  
Lukas Piliponis ◽  
Gintarė Neverauskaitė-Piliponienė ◽  
Monika Kazlauskaitė ◽  
Pavel Kačnov ◽  
Sigita Glaveckaitė ◽  
...  
Keyword(s):  
Subarachnoid Haemorrhage ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Regional Wall Motion ◽  
Left Ventricular ◽  
Stress Cardiomyopathy ◽  
Cardiac Biomarkers ◽  
Aneurysmal Subarachnoid Haemorrhage ◽  
Reduced Ejection Fraction ◽  
Neurogenic Stress

Summary Neurogenic stress cardiomyopathy (NSC) is defined as transient cardiac dysfunction occurring after primary brain injury, such as aneurysmal subarachnoid haemorrhage, and characterised by left ventricular systolic dysfunction with reduced ejection fraction and abnormalities of regional wall motion. It may also be suspected if elevated levels of cardiac biomarkers and ECG abnormalities are present. It is a reversible condition with favourable long-term prognosis if diagnosed and treated timely, however, NSC is associated with higher rates of early mortality and complications, including pulmonary oedema, cardiogenic shock, delayed cerebral ischaemia. Early diagnosis of the NSC is important in order to prevent these complications and reduce mortality. Management of the NSC is complicated and a multidisciplinary approach is usually required.

scholarly journals Acute Pancreatitis Complicated by Stress Cardiomyopathy With Persistent Apical Akinesis: A Case Report and Literature Review

2019 ◽  
Vol 7 ◽  
pp. 232470961989319
Author(s):  
Temidayo Abe ◽  
Melvin Simien ◽  
Hayes Dolphurs
Keyword(s):  
Acute Pancreatitis ◽  
Takotsubo Cardiomyopathy ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Regional Wall Motion ◽  
Left Ventricular ◽  
Stress Cardiomyopathy ◽  
Regional Wall Motion Abnormalities ◽  
Wall Motion Abnormalities

Takotsubo cardiomyopathy or stress cardiomyopathy is a transient reversible cardiomyopathy characterized by regional wall motion abnormalities that usually extend beyond a single epicardial vascular distribution. It is often precipitated by acute physical or emotional stressors. In this article, we present the case of a postmenopausal woman who was admitted for management of acute pancreatitis. On the second day of admission, she developed shortness of breath and electrocardiographic abnormalities. A transthoracic echocardiogram revealed left ventricular systolic dysfunction and apical akinesis, and coronary angiography revealed normal coronary arteries. She was diagnosed with takotsubo cardiomyopathy triggered by acute pancreatitis and started on guideline-directed heart failure medications. A follow-up echocardiogram 4 months later revealed persistent systolic dysfunction and apical akinesis.

scholarly journals Echocardiographic assessment of cardiac dysfunction in maintenance hemodialysis patients

2017 ◽  
Vol 5 (2) ◽  
pp. 97-100
Author(s):  
Md Zahid Alam ◽  
Mohammad Zakir Hossain
Keyword(s):  
Wall Motion ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Regional Wall Motion ◽  
Left Ventricular ◽  
Maintenance Hemodialysis ◽  
Ventricular Systolic Dysfunction ◽  
Before And After ◽  
Stage Renal Disease ◽  
End Stage

Background and Objectives: The hemodialysis (HD) procedure may acutely induce regional left ventricular systolic dysfunction. This study evaluated the echocardiographic parameters in patients with End Stage Renal Disease (ESRD) on HD and to correlate those with clinical findings, more specifically to see whether there is any change in ejection fraction (EF) by developing new regional wall motion abnormality (RWMA) after hemodialysis, and to correlate these changes with the symptoms & hemodynamic condition of the patients.Methodology: This prospective observational study was carried on a total of 100 adult ambulant patients with end stage renal disease (ESRD) on maintenance hemodialysis in the department of Hemodialysis, BIRDEM General Hospital, Shahbag, Dhaka. Their echocardiogram was done 30 min before and after the hemodialysis.Result: It was revealed that majority of the patients were above 60 years (39%), and male to female ratio of about 3:2. The study subjects had diabetes mellitus (79%), hypertension (96%), dyslipidemia (42%), and family history of ischemic heart disease (24%). Chest pain and breathlessness were present in 31% and 42% subjects respectively before hemodialysis. Palpitation (23%), dizziness (19%), oedema (43%) and raised JVP (15%) were seen in the study subjects. Mean (±SD) serum creatinine level was 9.38 (±2.22) mg/dl and hemoglobin level was 9.0 (±1.08) g/dl. Ejection fraction (EF) before hemodialysis were ?55, 40-54 & 30-39 in 62%, 34% and 4% study subjects respectively and after hemodialysis it was ?55, 40-54 & 30-39 in 44%, 46% and 10% study subjects respectively. After HD, left ventricular failure (LVF) occurred in 32% subjects. HD-induced regional left ventricular systolic dysfunction occurred in total 36 patients (36%) and total 14 (14%) patients developed LVF 30 minutes after dialysis. Patients with hemodialysis-induced left ventricular systolic dysfunction were more in those who had worse predialysis EF. Blood pressure, heart rate, chest pain, palpitation, raised Jugular Venous Pressure (JVP) and edema did not differ significantly before and after hemodialysis. Simple regression analysis revealed that the hemodialysis procedure significantly (P<0.05) induce regional left ventricular systolic dysfunction.Conclusions: HD acutely induces regional wall motion abnormalities in a significant proportion of patients. It occurs within 30 min after hemodialysis and is not related to changes in blood pressure, heart rate, JVP and oedema.Bangladesh Crit Care J September 2017; 5(2): 97-100

scholarly journals Resistant hyponatraemia in a patient with follicular lymphoma and heart failure with reduced ejection fraction: a case report

2021 ◽  
Vol 5 (5) ◽  
Author(s):  
Jennifer Butler ◽  
Firas Miro ◽  
Abdallah Al-Mohammad
Keyword(s):  
Heart Failure ◽  
Follicular Lymphoma ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Decompensated Heart Failure ◽  
Left Ventricular ◽  
Fluid Restriction ◽  
Reduced Ejection Fraction ◽  
Patients With Heart Failure ◽  
Difficult Challenge

Abstract Background Hyponatraemia is a common problem in patients with heart failure. It can be difficult to treat, especially in the presence of the patient’s needs for diuresis and manipulation of the renin–angiotensin–aldosterone system (RAAS). Case summary This concerns a 74-year-old woman with follicular lymphoma and severe global left ventricular systolic dysfunction secondary to treatment with R-CHOP chemotherapy. She presented a difficult challenge in the management of her decompensated heart failure alongside hyponatraemia as low as 113 mmol/L. This was resistant to standard treatment. The resistance to usual measures necessitated treatment with Tolvaptan, a selective arginine vasopressin V2 inhibitor used to treat hyponatraemia in syndrome of inappropriate anti-diuretic hormone. This, along with a strict fluid restriction of 500 mL/day, resolved the patient’s hyponatraemia and enabled her discharge home on tolerated heart failure treatment. She has now remained stable for almost 12 months. Discussion The potential causes of hyponatraemia are discussed along with the role of Tolvaptan in its management.

scholarly journals Primary care heart failure service identifies a missed cohort of heart failure patients with reduced ejection fraction

2021 ◽  
Author(s):  
Matthew Kahn ◽  
Antony D Grayson ◽  
Parminder S Chaggar ◽  
Marie J Ng Kam Chuen ◽  
Alison Scott ◽  
...  
Keyword(s):  
Heart Failure ◽  
Primary Care ◽  
Clinical Audit ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Treatment Optimization ◽  
Reduced Ejection Fraction ◽  
Diagnosis Codes ◽  
Receive Treatment

Abstract Aims We explored whether a missed cohort of patients in the community with heart failure (HF) and left ventricular systolic dysfunction (LVSD) could be identified and receive treatment optimization through a primary care heart failure (PCHF) service. Methods and results PCHF is a partnership between Inspira Health, National Health Service Cardiologists and Medtronic. The PCHF service uses retrospective clinical audit to identify patients requiring a prospective face-to-face consultation with a consultant cardiologist for clinical review of their HF management within primary care. The service is delivered via five phases: (i) system interrogation of general practitioner (GP) systems; (ii) clinical audit of medical records; (iii) patient invitation; (iv) consultant reviews; and (v) follow-up. A total of 78 GP practices (864 194 population) have participated. In total, 19 393 patients’ records were audited. HF register was 9668 (prevalence 1.1%) with 6162 patients coded with LVSD (prevalence 0.7%). HF case finder identified 9725 additional patients to be audited of whom 2916 patients required LVSD codes adding to the patient medical record (47% increase in LVSD). Prevalence of HF with LVSD increased from 0.7% to 1.05%. A total of 662 patients were invited for consultant cardiologist review at their local GP practice. The service found that within primary care, 27% of HF patients identified for a cardiologist consultation were eligible for complex device therapy, 45% required medicines optimization, and 47% of patients audited required diagnosis codes adding to their GP record. Conclusion A PCHF service can identify a missed cohort of patients with HF and LVSD, enabling the optimization of prognostic medication and an increase in device prescription.

scholarly journals Cardiac dysfunction evoked by ECG and echocardiography changes and release of cardiac biomarkers in patients with aneurysmal subarachnoid haemorrhage.

2019 ◽  
pp. 363-369
Author(s):  
Raluca Ungureanu ◽  
Mihai Dumitru ◽  
Gabriel Iacob
Keyword(s):  
Subarachnoid Haemorrhage ◽  
Cardiac Injury ◽  
Cerebral Haemorrhage ◽  
High Volume ◽  
Regional Wall Motion ◽  
Cardiac Biomarkers ◽  
Stunned Myocardium ◽  
Aneurysmal Subarachnoid Haemorrhage ◽  
Ecg Changes ◽  
Coronary Syndrome

The invisible brain-heart link has been observed and described for centuries now, although a greater interest in the matter has been manifested over the past several decades, especially in patients with aneurysmal subarachnoid haemorrhage (aSAH). We present the case of a patient with aSAH and signs of cardiac injury evoked by ECG changes and elevated cardiac enzymes. Furthermore, we reviewed current medical literature by searching the international database PubMed for recent articles on the subject of cardiac biomarkers, ECG and echocardiography changes in the setting of SAH. Our analysis of the selected articles, published between 2012 and 2018, revealed that 22 are patient population studies, 16 are case studies and 6 are reviews of the literature. The most common ECG changes were prolonged QTc andnonspecific ST/T-wave changes. Echocardiography changes included regional wall-motion abnormalities, typically involving the base of the heart (neurogenic stunned myocardium), yet there was also the scenario of Takotsubo cardiomyopathy (stress cardiomyopathy), which affects the apex of the heart. There is a significant statistical association of elevated levels of troponin and NT-proBNP with a bad outcome after SAH, and we should always keep in mind the dramatic scenario of misdiagnosing the cerebral haemorrhage and treating for a coronary syndrome instead. Therefore, the management of aSAH requires a close cooperation between neurosurgeons, intensivists, cardiologists and radiologists in high volume centres.

scholarly journals Stress Cardiomyopathy (Takotsubo Cardiomyopathy)

2009 ◽  
Vol 3 ◽  
pp. CMC.S3324 ◽  
Author(s):  
Samer Khouri ◽  
Naser Imran
Keyword(s):  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Significant Coronary Artery Disease ◽  
Left Ventricular ◽  
Stress Cardiomyopathy ◽  
Clinical Scenarios ◽  
History Of ◽  
Underlying Causes ◽  
Characteristic Features ◽  
Artery Disease

Background Due to the rise in the number of reports of stress cardiomyopathy in the literature, awareness of this condition is increasing. Although different names have been used to describe this condition, the similarities in clinical, electrocardiographic, echocardiographic and angiographic features suggest that they represent the same spectrum of diseases with different underlying causes. The pathophysiology of stress cardiomyopathy remains controversial. Methods We describe a series of four cases of stress cardiomyopathy admitted to our institution over a period of six months with different presentations, but similar clinical course, EKG, echocardiographic, and catheterization findings. The ages ranged from 22 to 81 years; all four females. All showed characteristic wall motion abnormalities by imaging in the absence of significant coronary artery disease, with spontaneous recovery of left ventricular function with conservative therapy. Results Although the patients presented with different clinical scenarios, all four showed characteristic features of stress cardiomyopathy suggesting that the pathophysiology affecting the myocardium was the same. We present a review of the literature with a discussion of the history of this condition, characteristic clinical features, and diagnostic criteria used in the past as well as the suggested pathophysiology of this condition. Conclusion Stress cardiomyopathy is an underdiagnosed reversible cardiomyopathy triggered by severe emotional or physical stress. It represents a spectrum of conditions with reversible severe left ventricular systolic dysfunction that includes neurogenic cardiomyopathy. It is not confined to the Japanese population and can affect people of any ethnic background or nationality.

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