title: Management of catecholamine-induced stunned myocardium--a case report.
abstract: Hypertensive, hypervolumic, and hemodilution therapy (triple-H therapy) is administered to patients with symptomatic cerebral vasospasm after intracranial aneurysm clipping. This therapy can sometimes result in cardiac dysfunction because of pharmacologically induced hyperadrenergic state. The diagnosis may be missed if blood pressure alone is monitored to guide triple-H therapy. In this report, we describe one such patient who developed cardiac failure after triple-H therapy. This was diagnosed by using a bioreactance noninvasive cardiac output monitoring. Continuous cardiac output monitoring by this technique facilitated treatment of cardiac failure with milrinone and dobutamine. At discharge, the patient had no neurologic deficits.
authors.affiliation: Department of Neuroanaesthesia, National Institute of Mental Health and Neurosciences, Bangalore, India.
authors.forename: Mohit
authors.initials: M
authors.lastname: Mittal
authors.affiliation: Department of Neuroanaesthesia, National Institute of Mental Health and Neurosciences, Bangalore, India. Electronic address: mrks1974@gmail.com.
authors.forename: M
authors.initials: M
authors.lastname: Radhakrishnan
authors.affiliation: Department of Neuroanaesthesia, National Institute of Mental Health and Neurosciences, Bangalore, India.
authors.forename: G S
authors.initials: GS
authors.lastname: UmamaheswaraRao
mesh_terms: D001794:Blood Pressure / Q000187:drug effects; D002316:Cardiotonic Agents / Q000627:therapeutic use; D002395:Catecholamines / Q000009:adverse effects*; D004280:Dobutamine / Q000627:therapeutic use; D004298:Dopamine / Q000009:adverse effects; D005260:Female; D005440:Fluid Therapy; D006333:Heart Failure / Q000139:chemically induced / Q000628:therapy; D006801:Humans; D007431:Intraoperative Complications / Q000139:chemically induced* / Q000188:drug therapy*; D008875:Middle Aged; D020105:Milrinone / Q000627:therapeutic use; D017682:Myocardial Stunning / Q000139:chemically induced* / Q000188:drug therapy*; D019635:Neurosurgical Procedures / Q000379:methods; D009638:Norepinephrine / Q000009:adverse effects; D013345:Subarachnoid Hemorrhage / Q000601:surgery; D014665:Vasodilator Agents / Q000627:therapeutic use
chemical_list: D002316:Cardiotonic Agents; D002395:Catecholamines; D014665:Vasodilator Agents; D004280:Dobutamine; D020105:Milrinone; D004298:Dopamine; D009638:Norepinephrine
keywords: Blood pressure; Cardiac output; Catecholamines; Stunned myocardium; Subarachnoid hemorrhage; Vasospasm