Introduction: Cardiac injury and dysfunction after subarachnoid hemorrhage (SAH) is a well-recognized phenomenon. Takotsubo cardiomyopathy (TTC) is characterized by reversible apical hypokinesia without obstructive coronary artery lesions. The incidence, characteristics, and outcome of TTC have not been well documented. The aim of this study was to elucidate the incidence, characteristics, and outcome after TTC followed by SAH.
Methods: We retrospectively reviewed 274 consecutive acute SAH cases who admitted to the Kokura Memorial Hospital between 2005 to 2014. The patients received electrocardiogram and echocardiography for the diagnosis of cardiac changes. The diagnosis of TTC was made by cardiologists. We collected the data including age, gender, location of the ruptured aneurysm, ejection fraction, presence of symptomatic vasospasm and delayed cerebral infarction from the medical records.
Results: Of 276 patients, Eight (2.9%) were diagnosed as TTC (mean age±standard deviation:64.8±17.0). All patients were female. Location of the aneurysm was as follows: two in anterior communicating artery, two in middle cerebral artery, one in internal carotid-posterior communicating artery. All cases exhibited sinus rhythm in the initial electrocardiogram. QT interval prolongation was observed in 6 cases (75.0%). Four out of 5 patients who received the follow-up echocardiogram showed recovery of the ejection fraction. Three patients needed intensive care for the recovery of cardiac function. Symptomatic vasospasm was observed in 3 patients and all fell into delayed cerebral infarction.
Conclusions: TTC after SAH might appear mainly in female. Although TTC is a reversible phenomenon, it might negatively impact on cerebral ischemia followed by symptomatic vasospasm. Initial diagnosis and intensive management with cardiologists may improve the outcome after TTC.
Patient Care: Initial intensive care for TTC will decrease the cerebral ischemia after SAH and improve the outcome.
Learning Objectives: By the conclusion of this session, participants should be able to describe the importance of collaboration with cardiologists for initial management of TTC after SAH.