Stress-induced cardiomyopathy in aneurysmal subarachnoid hemorrhage

Abstract

Introduction: Neurogenic stunned myocardium is well described after aneurysmal subarachnoid hemorrhage. Stress-induced cardiomyopathy (takotsubo cardiomyopathy) is a form of neurogenic stunned myocardium which is not common after subarachnoid hemorrhage. We describe a case report of stress-induced cardiomyopathy (takotsubo cardiomyopathy) after aneurysmal subarachnoid hemorrhage. Case report: A previously healthy postmenopausal woman suffered aneurysmal subarachnoid hemorrhage with consequent hydrocephalus. After external ventricular drainage, craniotomy and aneurysm of the posterior inferior cerebellar artery clipping, patient developed signs of acute coronary syndrome with heart failure. Transthoracic echocardiogram showed left ventricular apical ballooning and hypercontractile basal segments. On chest radiography bilateral pulmonary infiltrates were seen. Mechanical ventilation and continuous sedation were started. Five days after, patient was weaned from mechanical ventilation and extubated. On control echocardiogram, the signs of apical ballooning syndrome resolved. Conclusions: This case and review of the literature suggest stress-induced cardiomyopathy can mimic acute coronary syndrome after aneurysmal subarachnoid hemorrhage.