Hyperinsulinemic euglycemia therapy for stunned myocardium following subarachnoid hemorrhage.
The authors describe the clinical course of a 50-year-old woman who presented with life-threatening cardiac dysfunction after aneurysmal subarachnoid hemorrhage (Fisher Grade 4). The pathophysiology of cardiac injury in this setting is not fully understood, but excess sympathetic activation can lead to neurogenic stressed myocardium. A metabolic intervention using the continuous intravenous infusion of high doses of insulin with euglycemia resulted in a rapid improvement of cardiac contractility. The observed benefit could be due to better myocardial glucose utilization that could not have been achieved by catecholamine administration.
Vanderschuren
Abel
A
Department of Intensive Care Cliniques St-Luc, Université Catholique de Louvain, Brussels, Belgium.
Hantson
Philippe
P
D001786:Blood Glucose / Q000378:metabolism*; D002302:Cardiac Output; D003422:Critical Care; D004562:Electrocardiography; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D007262:Infusions, Intravenous; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use*; D008133:Long QT Syndrome / Q000188:drug therapy / Q000209:etiology; D008297:Male; D008875:Middle Aged; D017682:Myocardial Stunning / Q000188:drug therapy* / Q000209:etiology*; D013345:Subarachnoid Hemorrhage / Q000150:complications*; D013616:Tachycardia, Sinus / Q000188:drug therapy / Q000209:etiology; D019210:Troponin I / Q000097:blood
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin; D019210:Troponin I