Delayed cardiogenic shock and acute lung injury after aneurysmal subarachnoid hemorrhage.
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.
de Chazal
Ives
I
Division of Critical Care and Division of Critical Care Neurology, Mayo Medical Center, Saint Marys Hospital, Rochester, Minnesota.
Parham
William M
WM
Liopyris
Panayota
P
Wijdicks
Eelco F M
EFM
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*
D002316:Cardiotonic Agents