title: Cardiogenic shock complicating subarachnoid haemorrhage diagnosed as Tako Tsubo cardiomyopathy: a cautionary tale.
abstract: Tako Tsubo or "stress" cardiomyopathy and its variants are well recognised as potential causes of acute coronary presentations, with manifestations including chest pain, cardiac failure and arrhythmia. Similarly, subarachnoid haemorrhage may be associated with cardiac abnormalities. Tako Tsubo cardiomyopathy is a diagnosis of exclusion with typical left ventricular dysfunction in the absence of epicardial coronary disease, but importantly also after exclusion of an intracerebral insult. We describe a case of unrecognised intracerebral haemorrhage with left ventricular dysfunction consistent with both variant Tako Tsubo cardiomyopathy and subarachnoid haemorrhage in a patient treated with intra-aortic balloon pump counterpulsation and associated heparinisation.
authors.affiliation: Cardiovascular Unit, John Hunter Hospital, Lookout Rd, Locked Bag 1, Hunter Region Mail Centre, New Lambton, NSW 2305, Australia.
authors.forename: Hany
authors.initials: H
authors.lastname: Abed
authors.forename: Malcolm
authors.initials: M
authors.lastname: Barlow
authors.forename: Thomas
authors.initials: T
authors.lastname: Wellings
authors.forename: Neil
authors.initials: N
authors.lastname: Spratt
authors.forename: Nicholas
authors.initials: N
authors.lastname: Collins
mesh_terms: D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008875:Middle Aged; D011859:Radiography; D012770:Shock, Cardiogenic / Q000150:complications* / Q000000981:diagnostic imaging; D013345:Subarachnoid Hemorrhage / Q000150:complications* / Q000175:diagnosis / Q000000981:diagnostic imaging; D054549:Takotsubo Cardiomyopathy / Q000175:diagnosis* / Q000473:pathology; D018487:Ventricular Dysfunction, Left