title: Cardiogenic shock with stunned myocardium during triple-H therapy treated with intra-aortic balloon pump counterpulsation.
abstract: 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.
authors.affiliation: Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, 808, 1070, Brussels, Belgium. ftaccone@ulb.ac.be
authors.forename: Fabio Silvio
authors.initials: FS
authors.lastname: Taccone
authors.forename: Boris
authors.initials: B
authors.lastname: Lubicz
authors.forename: Michael
authors.initials: M
authors.lastname: Piagnerelli
authors.forename: Marc
authors.initials: M
authors.lastname: Van Nuffelen
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Vincent
authors.forename: Daniel
authors.initials: D
authors.lastname: De Backer
mesh_terms: 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
chemical_list: D014662:Vasoconstrictor Agents; D009638:Norepinephrine