ORIGINAL ARTICLES   

Chirurgia 2013 April;26(2):93-6

Copyright © 2013 EDIZIONI MINERVA MEDICA

language: English

The Broken Heart Syndrome in acute neurological injury. A troublesome source of secondary brain insults

Defillo A., Nussbaum E. S., Pulivarthi S., Zelensky A., Nussbaum L. A.

National Brain Aneurysm Center St. Joseph’s Hospital, St. Paul, MN, USA

Aim: The catecholamine mediated myocardial injury of Takotsubo’s syndrome (TS) after subarachnoid hemorrhage (SAH), has been reported by many as a transient condition, often with a favorable outcome. However, our experience provides evidence contradictory to that tenet. When combined with severe neurological injury, left ventricular dysfunction can contribute or lead to severe secondary brain insults from hypotension and hypoxia, thereby worsening patient outcome, and making this extra-cranial complication more serious than commonly suggested.
Methods: We present a synthesized analysis of aneurismal SAH (ASAH) in conjunction with TS. This analysis includes a series of three patients from our institution who presented with acute neurological deterioration and intracranial aneurysm who were diagnosed with Takotsubo’s cardiomyopathy. Additionally, we identified 20 patients with ASAH and TS presented in the current literature. We compared both groups of patients using available data points to determine in-hospital mortality and 30 day neurological outcome.
Results: Case reports of patients with TS most often describe a benign prognosis for the disease, with a very low complication rate. However, when calculating mortality and poor outcome, defined as modified Rakin scale (mRs) >3, within a group of patients with ASAH and TS, we observed an increase in both mortality and negative outcomes when SAH is the precipitating event.
Conclusion: Although they have similar pathways, neurogenic stunned myocardium and Takotsubo’s Syndrome are different entities. Despite being described as a transient condition, evidence supports that TS is associated with a more deleterious clinical presentation and outcome when combined with severe neurological injury.