Wu Eva M, El Ahmadieh Tarek Y, Kafka Benjamin, Davies Matthew T, Aoun Salah G, White Jonathan A
Department of Neurological Surgery, University of Texas Southwestern Medical School, Dallas, Texas, USA.
Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
World Neurosurg. 2018 Jun;114:252-256. doi: 10.1016/j.wneu.2018.03.151. Epub 2018 Mar 31.
Milrinone is an inotropic and vasodilatory drug proven safe for use in treatment of cerebral vasospasm. Despite its reported safety profile, its use is not free of side effects. Milrinone-associated cardiomyopathy and arrhythmia can occur in patients with cerebral vasospasm.
This is a retrospective chart review of a patient who presented with aneurysmal subarachnoid hemorrhage and developed clinical vasospasm twice over a period of 2 weeks. Sustained intravenous milrinone infusion was used in association with norepinephrine infusion during this period. The patient developed R-on-T triggered torsades de pointes and cardiogenic shock requiring resuscitation. Follow-up echocardiogram showed decreased ejection fraction from 64% to 43% consistent with cardiac remodeling. Systemic complications such as cardiotoxicity and arrhythmias with the use of intravenous milrinone can be seen particularly when used in combination with catecholamines.
With increased combined milrinone and catecholamine use for the treatment of cerebral vasospasm, physicians should be aware of the potential cardiac complications of these agents. Close monitoring with daily electrocardiograms may be helpful to detect changes that suggest cardiotoxicity. If changes are noted, an echocardiogram and cardiology consultation may be warranted.
米力农是一种具有正性肌力作用和血管舒张作用的药物，已被证明可安全用于治疗脑血管痉挛。尽管有报道称其安全性良好，但使用时并非没有副作用。脑血管痉挛患者可能会出现米力农相关的心肌病和心律失常。
这是一份对一名患者的回顾性病历审查，该患者出现动脉瘤性蛛网膜下腔出血，并在2周内两次发生临床血管痉挛。在此期间，持续静脉输注米力农并联合输注去甲肾上腺素。患者发生R波落在T波上触发的尖端扭转型室速和心源性休克，需要进行复苏。随访超声心动图显示射血分数从64%降至43%，符合心脏重塑。静脉使用米力农时可见全身并发症，如心脏毒性和心律失常，尤其是与儿茶酚胺联合使用时。
随着米力农和儿茶酚胺联合用于治疗脑血管痉挛的情况增多，医生应意识到这些药物潜在的心脏并发症。每日进行心电图密切监测可能有助于发现提示心脏毒性的变化。如果发现变化，可能需要进行超声心动图检查并咨询心脏病专家。
