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Neurogenic stunned myocardium

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Abstract

Neurogenic stunned myocardium may be defined as myocardial injury and dysfunction occurring after diverse types of acute brain injury as a result of imbalance of the autonomic nervous system. The spectrum of observed cardiac abnormalities includes electrocardiographic changes, arrhythmia, myocardial necrosis, release of B-type natriuretic peptide, and both systolic and diastolic dysfunction of the left ventricle. These are reversible abnormalities, and although management should include careful cardiac monitoring, treatments should generally focus on the underlying neurologic process to maximize neurologic recovery.

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References and Recommended Reading

  1. Lloyd-Jones D, Adams R, Carnethon M, et al.: Heart disease and stroke statistics-2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2009, 119:e21–e181.

    Article  PubMed  Google Scholar 

  2. Silver FL, Norris JW, Lewis AJ, Hachinski VC: Early mortality following stroke: a prospective review. Stroke 1984, 15:492–496.

    CAS  PubMed  Google Scholar 

  3. Hartmann A, Rundek T, Mast H, et al.: Mortality and causes of death after first ischemic stroke: the Northern Manhattan Stroke Study. Neurology 2001, 57:2000–2005.

    CAS  PubMed  Google Scholar 

  4. Natelson BH, Chang Q: Sudden death. A neurocardiologic phenomenon. Neurol Clin 1993, 11:293–308.

    CAS  PubMed  Google Scholar 

  5. Cheung RT, Hachinski V: The insula and cerebrogenic sudden death. Arch Neurol 2000, 57:1685–1688.

    Article  CAS  PubMed  Google Scholar 

  6. Burch GE, Meyers R, Abildskov JA: A new electrocardiographic pattern observed in cerebrovascular accidents. Circulation 1954, 9:719–723.

    CAS  PubMed  Google Scholar 

  7. Cheung RT, Hachinski V: Cardiac effects of stroke. Curr Treat Options Cardiovasc Med 2004, 6:199–207.

    Article  PubMed  Google Scholar 

  8. Sakr YL, Lim N, Amaral AC, et al.: Relation of ECG changes to neurological outcome in patients with aneurysmal subarachnoid hemorrhage. Int J Cardiol 2004, 96:369–373.

    Article  PubMed  Google Scholar 

  9. Di Pasquale G, Pinelli G, Andreoli A, et al.: Holter detection of cardiac arrhythmias in intracranial subarachnoid hemorrhage. Am J Cardiol 1987, 59:596–600.

    Article  PubMed  Google Scholar 

  10. Sommargren CE, Zaroff JG, Banki N, Drew BJ: Electrocardiographic repolarization abnormalities in subarachnoid hemorrhage. J Electrocardiol 2002, 35(Suppl):257–262.

    Article  Google Scholar 

  11. Banki N, Kopelnik A, Tung P, et al.: Prospective analysis of prevalence, distribution, and rate of recovery of left ventricular systolic dysfunction in patients with subarachnoid hemorrhage. J Neurosurg 2006, 105:15–20.

    Article  PubMed  Google Scholar 

  12. Andreoli A, di Pasquale G, Pinelli G, et al.: Subarachnoid hemorrhage: frequency and severity of cardiac arrhythmias. Stroke 1987, 18:558–564.

    CAS  PubMed  Google Scholar 

  13. Goldstein DS: The electrocardiogram in stroke: relationship to pathophysiological type and comparison with prior tracings. Stroke 1979, 10:253–259.

    CAS  PubMed  Google Scholar 

  14. Rem JA, Hachinski VC, Boughner DR, Barnett HJ: Value of cardiac monitoring and echocardiography in TIA and stroke patients. Stroke 1985, 16:950–956.

    CAS  PubMed  Google Scholar 

  15. Machado C, Baga JJ, Kawasaki R, et al.: Torsade de pointes as a complication of subarachnoid hemorrhage: a critical reappraisal. J Electrocardiol 1997, 30:31–37.

    Article  CAS  PubMed  Google Scholar 

  16. van den Bergh WM, Algra A, Rinkel GJ: Electrocardiographic abnormalities and serum magnesium in patients with subarachnoid hemorrhage. Stroke 2004, 35:644–648.

    Article  PubMed  Google Scholar 

  17. Frangiskakis MJ, Hravnak M, Crago EA, et al.: Ventricular arrhythmia risk after subarachnoid hemorrhage. Neurocrit Care 2009, 10:287–294.

    Article  PubMed  Google Scholar 

  18. Deibert E, Barzilai B, Braverman AC, et al.: Clinical significance of elevated troponin I levels in patients with nontraumatic subarachnoid hemorrhage. J Neurosurg 2003, 98:741–746.

    Article  PubMed  Google Scholar 

  19. Parekh N, Venkatesh B, Cross D, et al.: Cardiac troponin I predicts myocardial dysfunction in aneurysmal subarachnoid hemorrhage. J Am Coll Cardiol 2000, 36:1328–1335.

    Article  CAS  PubMed  Google Scholar 

  20. Tung P, Kopelnik A, Banki N, et al.: Predictors of neurocardiogenic injury after subarachnoid hemorrhage. Stroke 2004, 35:548–551.

    Article  PubMed  Google Scholar 

  21. Tung PP, Olmsted E, Kopelnik A, et al.: Plasma B-type natriuretic peptide levels are associated with early cardiac dysfunction after subarachnoid hemorrhage. Stroke 2005, 36:1567–1569.

    Article  CAS  PubMed  Google Scholar 

  22. Naidech AM, Kreiter KT, Janjua N, et al.: Cardiac troponin elevation, cardiovascular morbidity, and outcome after subarachnoid hemorrhage. Circulation 2005, 112:2851–2856.

    Article  CAS  PubMed  Google Scholar 

  23. McGirt MJ, Blessing R, Nimjee SM, et al.: Correlation of serum brain natriuretic peptide with hyponatremia and delayed ischemic neurological deficits after subarachnoid hemorrhage. Neurosurgery 2004, 54:1369–1373; discussion 1373–1374.

    Article  PubMed  Google Scholar 

  24. Yarlagadda S, Rajendran P, Miss JC, et al.: Cardiovascular predictors of in-patient mortality after subarachnoid hemorrhage. Neurocrit Care 2006, 5:102–107.

    Article  PubMed  Google Scholar 

  25. Kopelnik A, Fisher L, Miss JC, et al.: Prevalence and implications of diastolic dysfunction after subarachnoid hemorrhage. Neurocrit Care 2005, 3:132–138.

    Article  PubMed  Google Scholar 

  26. Kawahara E, Ikeda S, Miyahara Y, Kohno S: Role of autonomic nervous dysfunction in electrocardio-graphic abnormalities and cardiac injury in patients with acute subarachnoid hemorrhage. Circ J 2003, 67:753–756.

    Article  PubMed  Google Scholar 

  27. Tracey KJ: The inflammatory reflex. Nature 2002, 420:853–859.

    Article  CAS  PubMed  Google Scholar 

  28. Tsai FC, Marelli D, Bresson J, et al.: Use of hearts transplanted from donors with atraumatic intracranial bleeds. J Heart Lung Transplant 2002, 21:623–628.

    Article  PubMed  Google Scholar 

  29. Yamani MH, Starling RC, Cook DJ, et al.: Donor spontaneous intracerebral hemorrhage is associated with systemic activation of matrix metalloproteinase-2 and matrix metalloproteinase-9 and subsequent development of coronary vasculopathy in the heart transplant recipient. Circulation 2003, 108:1724–1728.

    Article  CAS  PubMed  Google Scholar 

  30. Yamani MH, Cook DJ, Tuzcu EM, et al.: Systemic up-regulation of angiotensin II type 1 receptor in cardiac donors with spontaneous intracerebral hemorrhage. Am J Transplant 2004, 4:1097–1102.

    Article  CAS  PubMed  Google Scholar 

  31. Mathiesen T, Edner G, Ulfarsson E, Andersson B: Cerebrospinal fluid interleukin-1 receptor antagonist and tumor necrosis factor-alpha following subarachnoid hemorrhage. J Neurosurg 1997, 87:215–220.

    Article  CAS  PubMed  Google Scholar 

  32. Kikuchi T, Okuda Y, Kaito N, Abe T: Cytokine production in cerebrospinal fluid after subarachnoid haemorrhage. Neurol Res 1995, 17:106–108.

    CAS  PubMed  Google Scholar 

  33. Kwon KY, Jeon BC: Cytokine levels in cerebrospinal fluid and delayed ischemic deficits in patients with aneurysmal subarachnoid hemorrhage. J Korean Med Sci 2001, 16:774–780.

    CAS  PubMed  Google Scholar 

  34. Hirashima Y, Nakamura S, Endo S, et al.: Elevation of platelet activating factor, inflammatory cytokines, and coagulation factors in the internal jugular vein of patients with subarachnoid hemorrhage. Neurochem Res 1997, 22:1249–1255.

    Article  CAS  PubMed  Google Scholar 

  35. Gruber A, Rossler K, Graninger W, et al.: Ventricular cerebrospinal fluid and serum concentrations of sTNFR-I, IL-1ra, and IL-6 after aneurysmal subarachnoid hemorrhage. J Neurosurg Anesthesiol 2000, 12:297–306.

    Article  CAS  PubMed  Google Scholar 

  36. Kopelnik A, Zaroff JG: Neurocardiogenic injury in neurovascular disorders. Crit Care Clin 2006, 22:733–752; abstract ix–x.

    Article  PubMed  Google Scholar 

  37. Banki NM, Kopelnik A, Dae MW, et al.: Acute neurocardiogenic injury after subarachnoid hemorrhage. Circulation 2005, 112:3314–3319.

    Article  PubMed  Google Scholar 

  38. Naidech A, Du Y, Kreiter KT, et al.: Dobutamine versus milrinone after subarachnoid hemorrhage. Neurosurgery 2005, 56:21–6l; discussion 6–7.

    PubMed  Google Scholar 

  39. Neil-Dwyer G, Walter P, Cruickshank J, et al.: Effect of propranolol and phentolamine on myocardial necrosis after subarachnoid haemorrhage. Br Med J 1978, 2:990–992.

    Article  CAS  PubMed  Google Scholar 

  40. van der Bilt IA, Hasan D, Vandertop WP, et al.: Impact of cardiac complications on outcome after aneurysmal subarachnoid hemorrhage: a meta-analysis. Neurology 2009, 72:635–642.

    Article  PubMed  Google Scholar 

  41. Coghlan LA, Hindman BJ, Bayman EO, et al.: Independent associations between electrocardiographic abnormalities and outcomes in patients with aneurysmal subarachnoid hemorrhage: findings from the intraoperative hypothermia aneurysm surgery trial. Stroke 2009, 40:412–418.

    Article  PubMed  Google Scholar 

  42. Dhamoon MS, Sciacca RR, Rundek T, et al.: Recurrent stroke and cardiac risks after first ischemic stroke: the Northern Manhattan Study. Neurology 2006, 66:641–646.

    Article  CAS  PubMed  Google Scholar 

  43. Laowattana S, Zeger SL, Lima JA, et al.: Left insular stroke is associated with adverse cardiac outcome. Neurology 2006, 66:477–83; discussion 63.

    Article  CAS  PubMed  Google Scholar 

  44. Miss JC, Kopelnik A, Fisher LA, et al.: Cardiac injury after subarachnoid hemorrhage is independent of the type of aneurysm therapy. Neurosurgery 2004, 55:1244–1250; discussion 50–51.

    Article  PubMed  Google Scholar 

  45. Mashaly HA, Provencio JJ: Inflammation as a link between brain injury and heart damage: the model of subarachnoid hemorrhage. Cleve Clin J Med 2008, 75:26–30.

    Article  Google Scholar 

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Correspondence to Jonathan G. Zaroff.

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Nguyen, H., Zaroff, J.G. Neurogenic stunned myocardium. Curr Neurol Neurosci Rep 9, 486–491 (2009). https://doi.org/10.1007/s11910-009-0071-0

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