Cardiomyopathy with inverted tako-tsubo pattern in the setting of subarachnoid hemorrhage: a series of four cases.

Autor: Shoukat S; Division of Cardiology, Emory University School of Medicine, 1365 Clifton Road, NE, 30322, Atlanta, GA, USA. sshouka@emory.edu, Awad A, Nam DK, Hoskins MH, Samuels O, Higginson J, Clements SD Jr
Jazyk: angličtina
Zdroj: Neurocritical care [Neurocrit Care] 2013 Apr; Vol. 18 (2), pp. 257-60.
DOI: 10.1007/s12028-011-9658-9
Abstrakt: Background: Severe subarachnoid hemorrhage may be associated with regional wall motion abnormalities (RWMA) in the absence of epicardial coronary occlusion. The RWMA extends beyond the distribution of a single coronary artery and may present in a typical tako-tsubo cardiomyopathy pattern. Other variants have also been recognized, including an inverted tako-tsubo pattern of severe basal hypokinesis that spares the apex. The mechanism of this cardiomyopathy is not well understood but likely involves catecholamine excess. While classic tako-tsubo cardiomyopathy from emotional stress carries a favorable prognosis, cardiac dysfunction from subarachnoid hemorrhage is a marker of overall poor prognosis.
Methods: We collected cases over a period of 4 years at a large teaching hospital. The cases represent cardiac dysfunction in the setting of subarachnoid hemorrhage in the unusual distribution of basal hypokinesis with relative sparing of the apex (inverted tako-tsubo pattern).
Results: A total of four cases were identified. All cases were female between the ages 43-67 years and had echocardiographic evidence of basal hypokinesis after suffering from an intracranial hemorrhage.
Conclusions: The typical and inverted patterns may represent a spectrum within the same disease process or distinct clinical entities with dramatically different prognostic implications. Larger studies comparing the two presentations will help elucidate this further.
Databáze: MEDLINE
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