title: Neurogenic stunned myocardium in subarachnoid hemorrhage.
abstract: "Stunned myocardium," characterized by reversible left ventricular dysfunction, was first described via animal models using transient coronary artery occlusion. However, this phenomenon has also been noted with neurologic pathologies and collectively been labeled "neurogenic stunned myocardium" (NSM). Neurogenic stunned myocardium resulting from subarachnoid hemorrhage (SAH) is a challenging pathology due to its diagnostic uncertainty. Traditional diagnostic criteria for NSM after SAH focus on electrocardiographic and echocardiographic abnormalities and troponemia. However, tremendous heterogeneity still exists. Traditional pathophysiological mechanisms for NSM encompassed hypothalamic and myocardial perivascular lesions. More recently, research on pathophysiology has centered on myocardial microvascular dysfunction and genetic polymorphisms. Catecholamine surging as a mechanism has also gained attention with particular focus placed on the role of adrenergic blockade in both the prehospital and acute settings. Management remains largely supportive with case reports acknowledging the utility of inotropes such as dobutamine and milrinone and intra-aortic balloon pump when NSM is accompanied by cardiogenic shock. Neurogenic stunned myocardium that follows SAH can result in many complications such as arrhythmias, pulmonary edema, and prolonged intubation, which can negatively impact long-term recovery from SAH and increase morbidity and mortality. This necessitates the need to accurately diagnose and treat NSM.
authors.affiliation: Department of Neurology, University of Tennessee Health Science Center, Memphis, TN.
authors.forename: Ali
authors.initials: A
authors.lastname: Kerro
authors.affiliation: Department of Cardiology, University of Tennessee Health Science Center, Memphis, TN.
authors.forename: Timothy
authors.initials: T
authors.lastname: Woods
authors.affiliation: Department of Neurology, University of Tennessee Health Science Center, Memphis, TN. Electronic address: jjwchang@hotmail.com.
authors.forename: Jason J
authors.initials: JJ
authors.lastname: Chang
mesh_terms: D003422:Critical Care; D004562:Electrocardiography; D006801:Humans; D017682:Myocardial Stunning / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D013345:Subarachnoid Hemorrhage / Q000150:complications*; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000175:diagnosis / Q000628:therapy*
keywords: Neurocardiac; Neurogenic stunned myocardium; Stunned myocardium; Subarachnoid hemorrhage; Takotsubo cardiomyopathy; Troponemia