Tako-tsubo cardiomyopathy: reversible heart failure with favorable outcome in patients with intracerebral hemorrhage

Abstract

In patients with intracerebal hemorrhage, cardiac dysfunction is a common phenomenon. Tako-tsubo cardiomyopathy is characterized by complete reversibility and therefore may constitute an entity with a favorable outcome. In this case report the authors describe a previously healthy 23-year-old man with no history of cardiac disease who suffered a severe fourth ventricular hemorrhage due to an angioma of the vermis cerebelli. After emergency surgery, progressive tachycardia, fibrillation, and electromechanical decoupling developed in the patient. An echocardiogram revealed left ventricular apical akinesia and basal hyperkinesis characteristic of tako-tsubo cardiomyopathy. One week after admission, cardiac function was normal. Tako-tsubo cardiomyopathy differs from common cardiac dysfunction in its reversible nature. This characteristic must be taken into consideration when treating patients with intracerebral hemorrhage to avoid misclassification of the disease.

Takotsubo cardiomyopathy in acute ischemic stroke

“…Dysfunction of left ventricular regional wall motion occurs in approximately 18% of SAH patients,20 and takotsubo cardiomyopathy was identified on ECG and imaging studies in 8 of 661 (1.2%) SAH patients 10. At least one patient with intracerebral hemorrhage was reported to have experienced development of takotsubo cardiomyopathy 21. This incidence of takotsubo cardiomyopathy in ischemic stroke patients (1.2%) suggests that the cardiomyopathy is as important a complication of ischemic stroke as of SAH.…”

Myocardial Infarction as a Complication in Acute Stroke: Results from the Austrian Stroke Unit Registry

“…This assumption is also supported by our data, showing a higher frequency of diabetes mellitus, hypercholesterolemia, smoking and coronary artery disease in ischemic stroke patients as opposed to ICH patients (data not shown). In contrast, neuronally induced autonomic cardiac dysfunction, as reported in subarachnoid hemorrhage and ICH for stress-induced cardiomyopathy, might be a rarer event [18,19,20]. Another study from Hays and Diringer [21] identified elevated troponin I levels to be independently associated with in-hospital mortality after ICH; however, only 3 out of 90 deaths were related to cardiac events.…”

CNS disease triggering Takotsubo stress cardiomyopathy

“…TTS following an ICH has been reported in nine cases so far [29,97,[120][121][122][123][124][125][126]. In four of these cases TTS was associated with cerebellar hemorrhage [29,97,125,126].…”