title: Delayed cardiogenic shock and acute lung injury after aneurysmal subarachnoid hemorrhage.
abstract: Both cardiac and lung injury after aneurysmal subarachnoid hemorrhage has been attributed to an adrenergic surge. Cardiogenic shock is very uncommon. We describe a 55-yr-old woman with a delayed cardiogenic shock emerging within hours after aneurysmal rupture. Cardiac damage was documented by increased serum troponin T, CPK-mb fraction, and severe wall motion abnormality, which included an akinetic apex on echocardiography (ejection fraction of 33%). Her coronary angiogram was normal. Decreased cardiac index, increased systemic and pulmonary vascular resistance indices, and persistent oxygen desaturation despite improving ventricular contractility documented both cardiac and pulmonary injury. After treatment with dobutamine and milrinone all manifestations resolved.
authors.affiliation: Division of Critical Care and Division of Critical Care Neurology, Mayo Medical Center, Saint Marys Hospital, Rochester, Minnesota.
authors.forename: Ives
authors.initials: I
authors.lastname: de Chazal
authors.forename: William M
authors.initials: WM
authors.lastname: Parham
authors.forename: Panayota
authors.initials: P
authors.lastname: Liopyris
authors.forename: Eelco F M
authors.initials: EFM
authors.lastname: Wijdicks
mesh_terms: D000328:Adult; D002316:Cardiotonic Agents / Q000627:therapeutic use; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging; D008171:Lung Diseases / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D019635:Neurosurgical Procedures; D011859:Radiography; D012770:Shock, Cardiogenic / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D013345:Subarachnoid Hemorrhage / Q000150:complications*
chemical_list: D002316:Cardiotonic Agents