title: Successful treatment of inverted Takotsubo cardiomyopathy after severe traumatic brain injury with milrinone after dobutamine failure.
abstract: BACKGROUND
  Takotsubo cardiomyopathy can occur at the early phase of severe acute brain injuries. In the case of cardiac output decrease or shock, the optimal treatment is still a matter of debate. Due to massive stress hormone release, the infusion of catecholamines may have limited effects and may even aggravate cardiac failure. Other inotropic agents may be an option. Levosimendan has been shown to have potential beneficial effects in this setting, although milrinone has not been studied.
  
  
  METHODS
  We report a case of a young female presenting with inverted Takotsubo cardiomyopathy syndrome after severe traumatic brain injury.
  
  
  RESULTS
  Due to hemodynamic instability and increasing levels of infused norepinephrine, dobutamine infusion was begun but rapidly stopped due to tachyarrhythmia. Milrinone infusion stabilized the patient's hemodynamic status and improved cardiac output without deleterious effects.
  
  
  CONCLUSIONS
  Milrinone could be a good alternative when inotropes are required in Takotsubo cardiomyopathy and when dobutamine infusion is associated with tachyarrhythmia.
authors.affiliation: Department of Anesthesia and Intensive Care, University Hospital of Toulouse, University Toulouse 3 Paul Sabatier, 31000 Toulouse, France. Electronic address: mrozek.s@chu-toulouse.fr.
authors.forename: Ségolène
authors.initials: S
authors.lastname: Mrozek
authors.affiliation: Department of Anesthesia and Intensive Care, University Hospital of Toulouse, University Toulouse 3 Paul Sabatier, 31000 Toulouse, France.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Srairi
authors.affiliation: Department of Anesthesia and Intensive Care, University Hospital of Toulouse, University Toulouse 3 Paul Sabatier, 31000 Toulouse, France.
authors.forename: Fouad
authors.initials: F
authors.lastname: Marhar
authors.affiliation: Department of Cardiology, University Hospital of Toulouse, University Toulouse 3 Paul Sabatier, 31000 Toulouse, France.
authors.forename: Clément
authors.initials: C
authors.lastname: Delmas
authors.affiliation: Department of Anesthesia and Intensive Care, University Hospital of Toulouse, University Toulouse 3 Paul Sabatier, 31000 Toulouse, France.
authors.forename: François
authors.initials: F
authors.lastname: Gaussiat
authors.affiliation: Department of Anesthesia and Intensive Care, University Hospital of Toulouse, University Toulouse 3 Paul Sabatier, 31000 Toulouse, France.
authors.forename: Timothée
authors.initials: T
authors.lastname: Abaziou
authors.affiliation: Department of Anesthesia and Intensive Care, University Hospital of Toulouse, University Toulouse 3 Paul Sabatier, 31000 Toulouse, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Larcher
authors.affiliation: Department of Anesthesia and Intensive Care, University Hospital of Toulouse, University Toulouse 3 Paul Sabatier, 31000 Toulouse, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Atthar
authors.affiliation: Department of Anesthesia and Intensive Care, University Hospital of Toulouse, University Toulouse 3 Paul Sabatier, 31000 Toulouse, France.
authors.forename: Rémi
authors.initials: R
authors.lastname: Menut
authors.affiliation: Department of Anesthesia and Intensive Care, University Hospital of Toulouse, University Toulouse 3 Paul Sabatier, 31000 Toulouse, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Fourcade
authors.affiliation: Department of Anesthesia and Intensive Care, University Hospital of Toulouse, University Toulouse 3 Paul Sabatier, 31000 Toulouse, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Geeraerts
mesh_terms: D000293:Adolescent; D000070642:Brain Injuries, Traumatic / Q000150:complications* / Q000175:diagnosis; D002316:Cardiotonic Agents / Q000008:administration & dosage; D004280:Dobutamine / Q000627:therapeutic use*; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D020105:Milrinone / Q000008:administration & dosage*; D054549:Takotsubo Cardiomyopathy / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D015599:Trauma Severity Indices; D017211:Treatment Failure
chemical_list: D002316:Cardiotonic Agents; D004280:Dobutamine; D020105:Milrinone
keywords: Catecholamines; Dobutamine; Milrinone; Takotsubo cardiomyopathy; Traumatic brain injury