Acute left ventricular dysfunction and subarachnoid hemorrhage.
OBJECTIVE
Severe left ventricular (LV) dysfunction associated with acute subarachnoid hemorrhage (SAH) due to cerebral aneurysm rupture.


METHODS
An adult 12-bed surgical intensive care unit of a university hospital.


METHODS
A female patient presenting with SAH (Hunt & Hess grade III) and severe left ventricular dysfunction.


METHODS
Central venous pressure, arterial blood pressure, extravascular lung water catheter, transesophageal echocardiography, blood gas analysis, electrocardiograms, and chest x-ray for clinical management.


RESULTS
On admission to the district hospital, an electrocardiogram (ECG) revealed a sinus rhythm with transient ST elevations. A transesophageal echocardiography showed a left ventricular ejection fraction (LV-EF) of approximately 10%. Severe LV dysfunction required inotropic and vasopressor support to maintain mean arterial pressure above 60 mmHg, while the first measurement of an extravascular lung water catheter revealed a cardiac index of 2.0 L/min/m2 and moderate hypovolemia. Despite stepwise volume loading that increased intrathoracic blood volume--an indicator of cardiac preload--from 719 mL/m2 to 927 mL/m2, cardiac index remained poor. Enoximone lead to a marked increase of cardiac index up to 3.9 L/min/m2 and LV-EF to about 30%, but had to be stopped due to thrombopenia. Surgical clipping of an intracranial aneurysm was postponed because of the impaired cardiac function and was performed on day 18 after admission. Interestingly, neurologic outcome was not as poor as might be expected from the literature.


CONCLUSIONS
Severe left ventricular dysfunction may occur in acute SAH and may necessitate delay of aneurysm surgery.
Sakka
S G
SG
Department of Anesthesiology and Intensive Care Medicine, Friedrich-Schiller University of Jena, FRG.
Huettemann
E
E
Reinhart
K
K
D000208:Acute Disease; D001794:Blood Pressure; D001810:Blood Volume; D002302:Cardiac Output; D002316:Cardiotonic Agents / Q000009:adverse effects / Q000627:therapeutic use; D002496:Central Venous Pressure; D017548:Echocardiography, Transesophageal; D004562:Electrocardiography; D017335:Enoximone / Q000009:adverse effects / Q000627:therapeutic use; D015633:Extravascular Lung Water; D005260:Female; D006801:Humans; D008875:Middle Aged; D013318:Stroke Volume; D013345:Subarachnoid Hemorrhage / Q000150:complications* / Q000601:surgery; D013921:Thrombocytopenia / Q000139:chemically induced; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000627:therapeutic use; D018487:Ventricular Dysfunction, Left / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology
D002316:Cardiotonic Agents; D014662:Vasoconstrictor Agents; D017335:Enoximone