Takotsubo Cardiomyopathy Induced by Dobutamine Infusion During Hypertensive Therapy for Symptomatic Vasospasm After Subarachnoid Hemorrhage -Case Report-

Abstract

A 65-year-old female with subarachnoid hemorrhage (SAH) developed takotsubo cardiomyopathy induced by dobutamine infusion for vasospasm 9 days after onset of SAH. She underwent neck clipping of the ruptured cerebral aneurysm on day 1. Course after surgery was uneventful, but she developed motor aphasia on day 9. Hypertensive therapy was carried out under the diagnosis of symptomatic vasospasm. Half an hour after initiation of dobutamine infusion at 6 mg/kg/min, sudden symptoms of takotsubo cardiomyopathy developed. Fortunately, her symptoms recovered in a few days with supportive therapy without any consequences. Takotsubo cardiomyopathy is one pattern of cardiac dysfunction occasionally encountered after SAH. Possible mechanisms of this disorder include epicardial catecholamine cardiotoxicity. Therefore, generally, cardiac function is worst at the early stage of SAH, when sympathetic activity is highest, and recovers thereafter. Dobutamine infusion seems to have triggered the takotsubo cardiomyopathy in the present patient even 9 days after onset of SAH. Inotropic agents including dobutamine are often used during the course of SAH, and since takotsubo cardiomyopathy can occur in patients with SAH, this complication must be considered.

CNS disease triggering Takotsubo stress cardiomyopathy

“…All eight patients were female and mean age was 55.5 years [37]. More rarely, TTS has been reported in single patients with SAB [25,36,[38][39][40][41][42][43][44][45][46][47][48][49][50][51]. Some patients with SAB may develop the inverse Takotsubo pattern in which the basal parts of the myocardium become hypo-or akinetic, whereas the apical parts are hyperkinetic (hyperdynamic) ( Table 1) [25,39,41,42,48,49].…”

Subarachnoid Hemorrhage Complicated With Neurogenic Pulmonary Edema and Takotsubo-Like Cardiomyopathy

“…The use of norepinephrine and dobutamine was avoided as far as possible because of the risk of exacerbating NPE-TCM. 20,28) Only the aneurysm that had ruptured was considered in the analysis of patients with multiple aneurysms. Patients with perimesencephalic SAH and patients presenting with cardiac arrest were excluded.…”

Mid-ventricular variant of dobutamine-induced stress cardiomyopathy

“…In a systematic review, 90% of study population had hypertension, hyperlipidemia and smoking as predisposing risk factors (6). Other comorbidities known to predispose include subarachnoid hemorrhage, following right ventricle outflow tract radiofrequency ablation and orthotopic heart transplantation (7)(8)(9). In our case, we believe that the following factors contributed to the development of DiSC in our patient.…”