Jain Rajan, Deveikis John, Thompson Byron G
Division of Neuroradiology and Department of Radiology, University of Michigan Health System, Ann Arbor, MI, USA.
AJNR Am J Neuroradiol. 2004 Jan;25(1):126-9.
Cardiac complications are well known after aneurysmal subarachnoid hemorrhage. Electrocardiographic changes occur in 50% to 100% of such cases. Arrhythmias, left ventricular dysfunction, and frank myocardial infarction are infrequently observed. Myocardial infarction must be differentiated from neurogenic stunned myocardium, which is a reversible condition. From 1996 to 2001, 105 patients with aneurysmal subarachnoid hemorrhage underwent endovascular treatment at the University of Michigan. Of these, four patients with no history of cardiac disease experienced cardiac failure related to neurogenic stunned myocardium. All had signs of left ventricular dysfunction, electrocardiographic changes, and elevated cardiac enzymes. Three had pulmonary edema at presentation. All were diagnosed with myocardial infarction. One underwent coronary angiography, which was normal. All were considered poor surgical candidates and underwent endovascular treatment of the aneurysms. Three of four patients developed symptomatic vasospasm, and two required balloon angioplasty. Three patients achieved good outcomes. The eldest died from severe vasospasm that was unresponsive to angioplasty. Reversible cardiac failure associated with subarachnoid hemorrhage may be due the neurogenic stunned myocardium. Frequent symptomatic vasospasm occurs, possibly related to poor cardiac output and the inability to optimize hyperdynamic hypervolemic therapy, particularly with compromised volume status. These patients can be treated with endovascular therapy of the aneurysms and balloon angioplasty as needed. With aggressive management, patients can recover from these reversible cardiac complications.
动脉瘤性蛛网膜下腔出血后心脏并发症众所周知。此类病例中50%至100%会出现心电图改变。心律失常、左心室功能障碍和明确的心肌梗死较少见。心肌梗死必须与神经源性心肌顿抑相鉴别，后者是一种可逆性病症。1996年至2001年，105例动脉瘤性蛛网膜下腔出血患者在密歇根大学接受了血管内治疗。其中，4例无心脏病史的患者发生了与神经源性心肌顿抑相关的心力衰竭。所有患者均有左心室功能障碍、心电图改变及心肌酶升高的迹象。3例患者就诊时出现肺水肿。所有患者均被诊断为心肌梗死。1例患者接受了冠状动脉造影，结果正常。所有患者均被认为不适合手术，接受了动脉瘤的血管内治疗。4例患者中有3例出现症状性血管痉挛，2例需要球囊血管成形术。3例患者预后良好。最年长的患者死于对血管成形术无反应的严重血管痉挛。与蛛网膜下腔出血相关的可逆性心力衰竭可能归因于神经源性心肌顿抑。频繁出现症状性血管痉挛，可能与心输出量低及无法优化高动力性高血容量治疗有关，尤其是在血容量状态不佳时。这些患者可接受动脉瘤的血管内治疗及必要时的球囊血管成形术。通过积极治疗，患者可从这些可逆性心脏并发症中康复。
