title: Neurogenic Stunned Myocardium Following Acute Subarachnoid Hemorrhage: Pathophysiology and Practical Considerations.
abstract: Neurogenic stunned myocardium (NSM) is a triad of transient left ventricular dysfunction, electrocardiogram changes, and elevation in cardiac enzymes, often mimicking a myocardial infarction. It has been described following acute brain injury. The purported mechanism is catecholamine excess resulting in cardiac dysfunction. From the clinical standpoint, the most frequently encountered electrocardiographic changes are QTc prolongation and ST-T changes, with modest elevations in troponin levels. Basal and mid-ventricular segments of the left ventricle are most commonly involved. NSM poses therapeutic challenges when it occurs secondary to aneurysmal subarachnoid hemorrhage, particularly in the setting of coexisting vasospasm. Overall, NSM carries good prognosis if recognized early, with appropriate management of hemodynamic and cardiopulmonary parameters.
authors.affiliation: Department of Vascular Neurology and Neurocritical Care, Baylor College of Medicine, Houston, TX, USA santoshbmurthy@gmail.com.
authors.forename: Santosh B
authors.initials: SB
authors.lastname: Murthy
authors.affiliation: Department of Vascular Neurology and Neurocritical Care, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Shreyansh
authors.initials: S
authors.lastname: Shah
authors.affiliation: Department of Vascular Neurology and Neurocritical Care, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Chethan P Venkatasubba
authors.initials: CP
authors.lastname: Rao
authors.affiliation: Department of Vascular Neurology and Neurocritical Care, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Bershad
authors.affiliation: Department of Vascular Neurology and Neurocritical Care, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Jose I
authors.initials: JI
authors.lastname: Suarez
mesh_terms: D004562:Electrocardiography; D006801:Humans; D017682:Myocardial Stunning / Q000209:etiology / Q000503:physiopathology*; D009206:Myocardium / Q000201:enzymology; D013345:Subarachnoid Hemorrhage / Q000150:complications*; D018487:Ventricular Dysfunction, Left
keywords: Takotsubo cardiomyopathy; myocardial stunning; neurogenic stunned myocardium; subarachnoid hemorrhage