Stress cardiomyopathy with an "inverse" takotsubo pattern in a patient with acute aneurysmal subarachnoid hemorrhage

Christine J Waller; Byron Vandenberg; David Hasan; Avinash B Kumar

doi:10.1111/echo.12266

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Stress cardiomyopathy with an "inverse" takotsubo pattern in a patient with acute aneurysmal subarachnoid hemorrhage

Journal article

Peer reviewed

Stress cardiomyopathy with an "inverse" takotsubo pattern in a patient with acute aneurysmal subarachnoid hemorrhage

Christine J Waller, Byron Vandenberg, David Hasan and Avinash B Kumar

Echocardiography (Mount Kisco, N.Y.), Vol.30(8), pp.E224-E226

09/2013

DOI: 10.1111/echo.12266

PMID: 23742227

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Abstract

Subarachnoid hemorrhage (SAH) induced myocardial dysfunction (often labeled neurogenic stunned myocardium) encompasses a spectrum of clinical presentations ranging from an isolated elevation of cardiac enzymes to cardiogenic shock. We describe a case of stress cardiomyopathy in a patient following acute aneurysmal subarachnoid hemorrhage that showed an "inverse" or reverse takotsubo pattern on echocardiography. The patient was a 46-year-old female who presented with acute cardiogenic shock following acute subarachnoid hemorrhage necessitating aggressive cardiorespiratory in the ICU. Her admission echo showed a depressed left ventricular ejection fraction of 25%. The basal 2/3 of the left ventricle (LV) was severely hypokinetic and the apical 1/3 of the LV was hypercontractile, i.e. the reverse or inverse takotsubo pattern of regional wall motion abnormality. With ongoing aggressive support her cardiovascular function steadily improved and on day 6 her follow up echo showed LV ejection fraction increased to 60-65% with resolution of the previous regional wall motion abnormality. The patient was discharged to a neuro-rehabilitation facility on day 16. The "inverse" or "reverse" takotsubo pattern of regional wall motion abnormalities, i.e. with preserved apical LV contractility and hypokinesis of the basal walls of the LV is more common in patients following acute SAH.

Acute Disease

Diagnosis, Differential

Humans

Middle Aged

Echocardiography - methods

Female

Subarachnoid Hemorrhage - diagnostic imaging

Takotsubo Cardiomyopathy - diagnostic imaging

Ventricular Dysfunction, Left - diagnostic imaging

Details

Title: Subtitle: Stress cardiomyopathy with an "inverse" takotsubo pattern in a patient with acute aneurysmal subarachnoid hemorrhage
Creators: Christine J Waller - University of Iowa, Iowa City, IA
Byron Vandenberg
David Hasan
Avinash B Kumar
Resource Type: Journal article
Publication Details: Echocardiography (Mount Kisco, N.Y.), Vol.30(8), pp.E224-E226
Publisher: United States
DOI: 10.1111/echo.12266
PMID: 23742227
ISSN: 0742-2822
eISSN: 1540-8175
Language: English
Date published: 09/2013
Academic Unit: Roy J. Carver Department of Biomedical Engineering; Radiology; Cardiovascular Medicine; Neurosurgery; Otolaryngology; Internal Medicine
Record Identifier: 9984040013702771

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