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 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 Haptoglobin genotype and outcome after aneurysmal subarachnoid haemorrhage

2020 ◽  
Vol 91 (3) ◽  
pp. 305-313 ◽  
Author(s):  
Matthew J Morton ◽  
Isabel C Hostettler ◽  
Nabila Kazmi ◽  
Varinder S Alg ◽  
Stephen Bonner ◽  
...  
Keyword(s):  
Subarachnoid Haemorrhage ◽  
High Volume ◽  
Expression Level ◽  
Aneurysmal Subarachnoid Haemorrhage ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Fisher Grade ◽  
Haptoglobin Genotype ◽  
Low Volume

ObjectiveAfter aneurysmal subarachnoid haemorrhage (aSAH), extracellular haemoglobin (Hb) in the subarachnoid space is bound by haptoglobin, neutralising Hb toxicity and helping its clearance. Two exons in the HP gene (encoding haptoglobin) exhibit copy number variation (CNV), giving rise to HP1 and HP2 alleles, which influence haptoglobin expression level and possibly haptoglobin function. We hypothesised that the HP CNV associates with long-term outcome beyond the first year after aSAH.MethodsThe HP CNV was typed using quantitative PCR in 1299 aSAH survivors in the Genetics and Observational Subarachnoid Haemorrhage (GOSH) Study, a retrospective multicentre cohort study with a median follow-up of 18 months. To investigate mediation of the HP CNV effect by haptoglobin expression level, as opposed to functional differences, we used rs2000999, a single nucleotide polymorphism associated with haptoglobin expression independent of the HP CNV. Outcome was assessed using modified Rankin and Glasgow Outcome Scores. SAH volume was dichotomised on the Fisher grade. Haemoglobin-haptoglobin complexes were measured in cerebrospinal fluid (CSF) of 44 patients with aSAH and related to the HP CNV.ResultsThe HP2 allele associated with a favourable long-term outcome after high-volume but not low-volume aSAH (multivariable logistic regression). However rs2000999 did not predict outcome. The HP2 allele associated with lower CSF haemoglobin-haptoglobin complex levels. The CSF Hb concentration after high-volume and low-volume aSAH was, respectively, higher and lower than the Hb-binding capacity of CSF haptoglobin.ConclusionThe HP2 allele carries a favourable long-term prognosis after high-volume aSAH. Haptoglobin and the Hb clearance pathway are therapeutic targets after aSAH.

Role of the Cardiologist in Management of Subarachnoid Haemorrhage

2002 ◽  
Vol 15 (5) ◽  
pp. 625-633 ◽  
Author(s):  
F. Gaita ◽  
L. Formato ◽  
F. Bianchi ◽  
L. Vivalda ◽  
C. Giustetto ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Subarachnoid Haemorrhage ◽  
Pulmonary Oedema ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Aneurysmal Subarachnoid Haemorrhage ◽  
Ecg Changes ◽  
St Segment ◽  
Ecg Abnormalities

Patients with aneurysmal subarachnoid haemorrhage (SAH) frequently have cardiovascular complications that include: blood pressure fluctuations, cardiac arrhythmias and ECG changes. ECG abnormalities, haemodynamic instability and pulmonary oedema, frequently associated with this pathologic condition, contribute to the morbidity and mortality of subarachnoid haemorrhage (SAH). Actually ECG changes occur in 50% to 100% of the patients during the acute stage of SAH, with the most common abnormalities involving the ST segment, T wave and QT interval. In most cases, these abnormalities are clinically inconsequential and are attributed to neurally mediated electrophysiological effects. Some SAH patients, however, show evidence of structural cardiac damage. ECG abnormalities which are indistinguishable from those due to acute myocardial infarction (ST segment elevation or depression) have occasionally been reported in SAH. These patients exhibited findings (which are completely reversible) similar to an acute myocardial infarction on ECG examination, as well as elevated cardiac enzymes and findings of left ventricular wall motion abnormalities, mostly anterior wall akynesis, causing the reduction of left ventricular ejection fraction. Occurrence of pulmonary oedema has been described in ten to 25% of SAH patients. Pulmonary oedema may be neurogenic or cardiogenic in origin and both are a consequence of increased adrenergic tone. There is evidence that the most important consequence of cardiovascular effects secondary to subarachnoid haemorrhage is increased susceptibility to sudden death. The increased adrenergic tone, due to high catecholamine levels and sympathetic cranial nerves stimulation can explain the origin of tachyarrhythmias. The mechanism proposed to explain the origin of bradyarrhythmias is an increased vagal tone.

State-of-the-art diagnosis of myocardial infarction

Diagnosis ◽  
2016 ◽  
Vol 3 (4) ◽  
pp. 137-142 ◽  
Author(s):  
Mehrshad Vafaie
Keyword(s):  
Myocardial Infarction ◽  
Myocardial Necrosis ◽  
High Sensitivity ◽  
Regional Wall Motion ◽  
Cardiac Biomarkers ◽  
Risk Scores ◽  
Optimal Timing ◽  
Reference Limit ◽  
Coronary Syndrome ◽  
Definition Of

AbstractThe current version of the Universal Definition of Myocardial Infarction (MI) was published in 2012. An acute myocardial infarction (AMI) is characterized by evidence of myocardial necrosis in a clinical setting of acute myocardial ischemia. Diagnostic criteria include a rise and/or fall of serially tested cardiac biomarkers (preferentially cardiac troponins) with at least one value above the 99th percentile of the upper reference limit combined with symptoms of ischemia, new changes on electrocardiogram (ECG), imaging evidence of a new loss of viable myocardium or new regional wall motion abnormalities or the identification of an intracoronary thrombus by angiography or autopsy. Compared to previous versions, the current definition of MI includes minor modifications regarding ECG criteria and subtypes of MI as well as the use of cardiac imaging and high sensitivity troponin assays. This article summarizes the Universal MI definition and includes recommendations from the current guidelines for the management of patients with acute coronary syndrome. Strategies for “early rule-in” and “rule-out” of non-ST-elevation MI with high sensitivity cardiac troponin assays, risk scores for assessment of ischemic and bleeding risk and criteria for optimal timing of angiography are presented.

scholarly journals Subarachnoid haemorrhage mimicking as myocardial infarction

2017 ◽  
Vol 5 (2) ◽  
pp. 707
Author(s):  
Amanjeet S. Kindra ◽  
Abhimanyu Pandit ◽  
Suryanarayanan Bhaskar
Keyword(s):  
Myocardial Infarction ◽  
Subarachnoid Haemorrhage ◽  
Myocardial Injury ◽  
Artery Aneurysm ◽  
Acute Chest Pain ◽  
Anterior Communicating Artery ◽  
Ecg Changes ◽  
Coronary Syndrome ◽  
History Of ◽  
Reversible Condition

Electrocardiographic (ECG) changes due to subarachnoid haemorrhage (SAH) are seen frequently and mimic acute myocardial infarction. For appropriate therapeutic management it is very important to distinguish acute coronary syndrome from neurogenic myocardial injury, which is a reversible condition. A 35 year old male presented to us with history of acute chest pain, ECG suggestive of anterolateral myocardial infarction for which he underwent anticoagulant therapy. It was subsequently diagnosed to be a case of SAH due to ruptured anterior communicating artery aneurysm.

scholarly journals Role of Creatine Kinase in the Troponin Era: A Systematic Review

2021 ◽  
Vol 22 (6) ◽  
pp. 1291-1294
Author(s):  
Daniel Beamish ◽  
Tetyana Maniuk ◽  
Muhammad Mukarram ◽  
Venkatesh Thiruganasambandamoorthy
Keyword(s):  
Systematic Review ◽  
Creatine Kinase ◽  
Chest Pain ◽  
Cardiac Injury ◽  
Final Analysis ◽  
Cardiac Biomarkers ◽  
Coronary Syndrome ◽  
Pain Patients ◽  
Negative Conclusion

Introduction: The diagnosis of non-ST-elevated myocardial infarction (NSTEMI) depends on a combination of history, electrocardiogram, and cardiac biomarkers. The most sensitive and specific biomarkers for cardiac injury are the troponin assays. Many hospitals continue to automatically order less sensitive and less specific biomarkers such as creatine kinase (CK) alongside cardiac troponin (cTn) for workup of patients with chest pain. The objective of this systematic review was to identify whether CK testing is useful in the workup of patients with NSTEMI symptoms. Methods: We undertook a systematic review to ascertain whether CK ordered as part of the workup for NSTEMI was useful in screening patients with cardiac chest pain. The MEDLINE, Embase, and Cochrane databases were searched from January 1995–September 2020. Additional papers were added after consultation with experts. We screened a total of 2,865 papers, of which eight were included in the final analysis. These papers all compared CK and cTn for NSTEMI diagnosis. Results: In each of the eight papers included in the analysis, cTn showed a greater sensitivity and specificity than CK in the diagnosis of NSTEMI. Furthermore, none of the articles published reliable evidence that CK is useful in NSTEMI diagnosis when troponin was negative. Conclusion: There is no evidence to continue to use CK as part of the workup of NSTEMI acute coronary syndrome in undifferentiated chest pain patients. We conclude that CK should not be used to screen patients presenting to the emergency department with chest pain.

scholarly journals Reversible Stress Cardiomyopathy Presenting as Acute Coronary Syndrome with Elevated Troponin in the Absence of Regional Wall Motion Abnormalities: A Forme Fruste of Stress Cardiomyopathy?

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Mahesh Anantha Narayanan ◽  
Vimalkumar Veerappan Kandasamy ◽  
Satish Chandraprakasam ◽  
Aryan Mooss
Keyword(s):  
Acute Coronary Syndrome ◽  
Wall Motion ◽  
Regional Wall Motion ◽  
Stress Cardiomyopathy ◽  
Cardiac Biomarkers ◽  
Surgical Patient ◽  
Regional Wall ◽  
Coronary Syndrome ◽  
Regional Wall Motion Abnormalities ◽  
Wall Motion Abnormalities

We present a case of reversible stress cardiomyopathy in a surgical patient, described here as a forme fruste due to its atypical features. It is important to recognize such unusual presentation of stress cardiomyopathy that mimics acute coronary syndrome. Stress cardiomyopathy commonly presents as acute coronary syndrome and is characterized by typical or atypical variants of regional wall motion abnormalities. We report a 60-year-old Caucasian male with reversible stress cardiomyopathy following a sternal fracture fixation. Although the patient had several typical features of stress cardiomyopathy including physical stress, ST-segment elevation, elevated cardiac biomarkers and normal epicardial coronaries, there were few features that were atypical, including unusual age, gender, absence of regional wall motion abnormalities, high lateral ST elevation, and high troponin-ejection fraction product. In conclusion, this could represent a forme fruste of stress cardiomyopathy.

scholarly journals Kounis syndrome secondary to nimesulide ingestion: a case report

2021 ◽  
Vol 73 (1) ◽  
Author(s):  
Yamasandi Siddegowda Shrimanth ◽  
Krishna Santosh Vemuri ◽  
Atit A. Gawalkar ◽  
Soumitra Ghosh ◽  
Jyothi Vijay ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Hypersensitivity Reaction ◽  
Regional Wall Motion ◽  
Maculopapular Rash ◽  
Coronary Intervention ◽  
Cardiac Biomarkers ◽  
Drug Eluting Stent ◽  
Allergic Reactions ◽  
Kounis Syndrome ◽  
Coronary Syndrome

Abstract Background Kounis syndrome, also known as "allergic myocardial infarction," is a rare co-occurrence of acute coronary syndrome (ACS) in the setting of hypersensitivity reaction to any agent. Non-steroidal anti-inflammatory drugs (NSAIDs) like are often implicated in causing allergic reactions. Here, we present a case of anterior wall myocardial infarction (AWMI) occurred following angioedema secondary to intake of Nimesulide, not described earlier in literature. Case presentation A 45-year-old female developed generalized pruritic, erythematous maculopapular rash, facial puffiness, oral ulcers and hoarseness of voice within few hours following consumption of Nimesulide for fever and body-ache. Due to development of hypotension, electrocardiogram (ECG) was done, which revealed ST elevation in V2–V6, with marked elevation of troponin (TnI) and creatine kinase (CK-MB). He had no chest pain or shortness of breath. Echocardiography showed regional wall motion (RWMA) abnormality in left anterior descending artery (LAD) territory with an ejection fraction of 25%. Coronary angiography showed a complete thrombotic cutoff of LAD, for which Tirofiban infusion was started to decrease thrombus burden. Repeat angiography on next day showed 80% lesion in proximal LAD for which she underwent revascularization with a drug-eluting stent. The patient later showed improvement in cardiac function at 8 months of follow-up. Conclusions The occurrence of ACS requiring percutaneous coronary intervention (PCI) in the setting of allergic reactions is rarely reported in the literature. One should be aware of the rare possibility of Kounis syndrome in the setting of hypersensitivity reaction when accompanying features of symptoms suggestive of coronary artery disease co-exists. When indicated, ECG monitoring and cardiac biomarkers in patients with allergic responses help to identify this rare and treatable condition.

An Atypical Presentation of Acute Coronary Syndrome

2012 ◽  
Vol 8 (1) ◽  
pp. 67
Author(s):  
Syed Khurram Mushtaq Gardezi ◽  
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Systolic Function ◽  
Artery Bypass ◽  
Left Ventricular Systolic Function ◽  
Regional Wall Motion ◽  
Dobutamine Stress ◽  
Left Ventricular ◽  
Ventricular Systolic Function ◽  
Coronary Syndrome

A 61-year-old man was admitted to hospital with severe occipital headache and weakness and numbness of the left arm. His electrocardiograms showed changes hinting at acute coronary syndrome (ACS). However, in view of his clinical presentation, he underwent tests for likely subarachnoid haemorrhage, but this was ruled out. The next day, he was referred to cardiology. A transthoracic echocardiogram showed reduced left ventricular systolic function along with regional wall motion abnormalities involving inferoposterior walls. The patient was treated as per the protocol for ACS. A dobutamine stress echocardiogram confirmed inferior myocardial infarction with evidence of myocardial viability in the affected left ventricular segments. Subsequent investigations confirmed three-vessel coronary artery disease and reduced left ventricular systolic function. The patient underwent successful coronary artery bypass grafting.

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