Neurogenic Stunned Myocardium Progressing to Takotsubo Cardiomyopathy with Milrinone
A 67-year-old female came with acute-onset headache and altered sensorium secondary to a ruptured right giant supraclinoid internal carotid artery aneurysm. Echocardiography revealed global wall motion abnormalities. She underwent aneurysm clipping on day 4 following ictus and her postoperative Glas...
Saved in:
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Thieme Medical and Scientific Publishers Pvt. Ltd.
|
| Series: | Journal of Neuroanaesthesiology and Critical Care |
| Subjects: | |
| Online Access: | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0045-1809056 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850189528232361984 |
|---|---|
| author | Siddharth Srinivasan Arjun Balakrishnan Rajesh P. Nair Girish Menon |
| author_facet | Siddharth Srinivasan Arjun Balakrishnan Rajesh P. Nair Girish Menon |
| author_sort | Siddharth Srinivasan |
| collection | DOAJ |
| description | A 67-year-old female came with acute-onset headache and altered sensorium secondary to a ruptured right giant supraclinoid internal carotid artery aneurysm. Echocardiography revealed global wall motion abnormalities. She underwent aneurysm clipping on day 4 following ictus and her postoperative Glasgow Coma Scale (GCS) score was E2VTM5. She developed an infarct in the caudate nucleus for which milrinone infusion was started. Following milrinone infusion her blood pressure dropped significantly. Despite stopping milrinone, it did not respond to noradrenaline or dopamine. Investigations revealed a troponin of 0.6 ng/mL, and electrocardiogram showed new ST-T changes in leads V3-V6. Echocardiography showed paradoxical apical excursion, suggestive of Takotsubo cardiomyopathy. She was started on vasopressin, her blood pressure stabilized, and noradrenaline was gradually tapered. Due to prolonged hypoperfusion, however, GCS dropped to E2VTM3. Eventually, inotropes were stopped, and cardiac contractility recovered. The patient had a sudden drop in GCS on postoperative day 25 and died. |
| format | Article |
| id | doaj-art-b0f60f9f221e463b87e6817dce327794 |
| institution | OA Journals |
| issn | 2348-0548 2348-926X |
| language | English |
| publisher | Thieme Medical and Scientific Publishers Pvt. Ltd. |
| record_format | Article |
| series | Journal of Neuroanaesthesiology and Critical Care |
| spelling | doaj-art-b0f60f9f221e463b87e6817dce3277942025-08-20T02:15:36ZengThieme Medical and Scientific Publishers Pvt. Ltd.Journal of Neuroanaesthesiology and Critical Care2348-05482348-926X10.1055/s-0045-1809056Neurogenic Stunned Myocardium Progressing to Takotsubo Cardiomyopathy with MilrinoneSiddharth Srinivasan0Arjun Balakrishnan1https://orcid.org/0000-0002-6155-6278Rajesh P. Nair2Girish Menon3Department of Neurosurgery, Fortis Hospital, New Delhi, IndiaDepartment of Anesthesiology, Kasturba Medical College - Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, IndiaDepartment of Neurosurgery, Adarsha Hospitals, Udupi, Karnataka, IndiaDepartment of Neurosurgery, Kasturba Medical College - Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, IndiaA 67-year-old female came with acute-onset headache and altered sensorium secondary to a ruptured right giant supraclinoid internal carotid artery aneurysm. Echocardiography revealed global wall motion abnormalities. She underwent aneurysm clipping on day 4 following ictus and her postoperative Glasgow Coma Scale (GCS) score was E2VTM5. She developed an infarct in the caudate nucleus for which milrinone infusion was started. Following milrinone infusion her blood pressure dropped significantly. Despite stopping milrinone, it did not respond to noradrenaline or dopamine. Investigations revealed a troponin of 0.6 ng/mL, and electrocardiogram showed new ST-T changes in leads V3-V6. Echocardiography showed paradoxical apical excursion, suggestive of Takotsubo cardiomyopathy. She was started on vasopressin, her blood pressure stabilized, and noradrenaline was gradually tapered. Due to prolonged hypoperfusion, however, GCS dropped to E2VTM3. Eventually, inotropes were stopped, and cardiac contractility recovered. The patient had a sudden drop in GCS on postoperative day 25 and died.http://www.thieme-connect.de/DOI/DOI?10.1055/s-0045-1809056neurogenic stunned myocardiumTakotsubo cardiomyopathymilrinone |
| spellingShingle | Siddharth Srinivasan Arjun Balakrishnan Rajesh P. Nair Girish Menon Neurogenic Stunned Myocardium Progressing to Takotsubo Cardiomyopathy with Milrinone Journal of Neuroanaesthesiology and Critical Care neurogenic stunned myocardium Takotsubo cardiomyopathy milrinone |
| title | Neurogenic Stunned Myocardium Progressing to Takotsubo Cardiomyopathy with Milrinone |
| title_full | Neurogenic Stunned Myocardium Progressing to Takotsubo Cardiomyopathy with Milrinone |
| title_fullStr | Neurogenic Stunned Myocardium Progressing to Takotsubo Cardiomyopathy with Milrinone |
| title_full_unstemmed | Neurogenic Stunned Myocardium Progressing to Takotsubo Cardiomyopathy with Milrinone |
| title_short | Neurogenic Stunned Myocardium Progressing to Takotsubo Cardiomyopathy with Milrinone |
| title_sort | neurogenic stunned myocardium progressing to takotsubo cardiomyopathy with milrinone |
| topic | neurogenic stunned myocardium Takotsubo cardiomyopathy milrinone |
| url | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0045-1809056 |
| work_keys_str_mv | AT siddharthsrinivasan neurogenicstunnedmyocardiumprogressingtotakotsubocardiomyopathywithmilrinone AT arjunbalakrishnan neurogenicstunnedmyocardiumprogressingtotakotsubocardiomyopathywithmilrinone AT rajeshpnair neurogenicstunnedmyocardiumprogressingtotakotsubocardiomyopathywithmilrinone AT girishmenon neurogenicstunnedmyocardiumprogressingtotakotsubocardiomyopathywithmilrinone |