Cardiogenic shock with stunned myocardium during triple-H therapy treated with intra-aortic balloon pump counterpulsation.
BACKGROUND
Excessive use of adrenergic agents may result in stunned myocardium.


METHODS
We report the cases of two patients with subarachnoid hemorrhage (SAH) complicated by cardiogenic shock secondary to triple-H therapy for cerebral vasospasm. Both patients had normal cardiac function on admission and no signs of acute myocardial infarction at the onset of cardiogenic shock. Intra-aortic balloon pump (IABP) counterpulsation was used to maintain adequate cerebral perfusion while enabling the high doses of norepinephrine that were being administered to be reduced. Reversal of the myocardial dysfunction after vasopressors were discontinued supported a diagnosis of catecholamine-induced stunned myocardium.


CONCLUSIONS
IABP counterpulsation may be one therapeutic option for patients with vasospasm after SAH when high doses of vasopressors can induce severe myocardial dysfunction. However, this invasive device may not be sufficient to maintain adequate cerebral perfusion and fatal embolic events can complicate the clinical course.
Taccone
Fabio Silvio
FS
Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, 808, 1070, Brussels, Belgium. ftaccone@ulb.ac.be
Lubicz
Boris
B
Piagnerelli
Michael
M
Van Nuffelen
Marc
M
Vincent
Jean-Louis
JL
De Backer
Daniel
D
D000328:Adult; D005260:Female; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D008875:Middle Aged; D017682:Myocardial Stunning / Q000139:chemically induced / Q000175:diagnosis / Q000628:therapy*; D009638:Norepinephrine / Q000009:adverse effects*; D012770:Shock, Cardiogenic / Q000139:chemically induced / Q000175:diagnosis / Q000628:therapy*; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000628:therapy; D014662:Vasoconstrictor Agents / Q000009:adverse effects*; D020301:Vasospasm, Intracranial / Q000209:etiology / Q000628:therapy
D014662:Vasoconstrictor Agents; D009638:Norepinephrine