Okajima Masaki, Koshida Yoshinao, Noda Toru, Taniguchi Takumi
Intensive Care Unit Kanazawa University Hospital Kanazawa Ishikawa Japan.
Acute Med Surg. 2013 Dec 26;1(2):115-118. doi: 10.1002/ams2.14. eCollection 2014 Apr.
A 53-year-old woman with coma was diagnosed with subarachnoid hemorrhage and ruptured aneurysm at the right internal carotid-posterior communicating artery.
The aneurysm was successfully clipped. Severe hypoxia and shock with abnormal left ventricular contraction were observed. We diagnosed severe acute heart failure with cardiogenic shock due to takotsubo cardiomyopathy complicated by subarachnoid hemorrhage. Neither catecholamine nor intra-aortic balloon pumping was selected to treat severe acute heart failure with cardiogenic shock because catecholamine generally worsens takotsubo cardiomyopathy and hematoma after surgery. Therefore, we gave olprinone and improved hypoxia and hemodynamics immediately without any arrhythmia.
Olprinone was effective for severe acute heart failure with cardiogenic shock due to takotsubo cardiomyopathy accompanied by subarachnoid hemorrhage. Catecholamine agents should be avoided if possible in patients with takotsubo cardiomyopathy. A phosphodiesterase III inhibitor may be useful for cardiogenic shock caused by takotsubo cardiomyopathy.
一名53岁昏迷女性被诊断为蛛网膜下腔出血，右侧颈内动脉-后交通动脉处动脉瘤破裂。
动脉瘤成功夹闭。观察到严重缺氧和休克，伴有左心室收缩异常。我们诊断为应激性心肌病并发蛛网膜下腔出血导致的严重急性心力衰竭伴心源性休克。由于儿茶酚胺通常会使应激性心肌病恶化并导致术后血肿，因此未选择儿茶酚胺或主动脉内球囊反搏来治疗严重急性心力衰竭伴心源性休克。因此，我们给予奥普力农，立即改善了缺氧状况和血流动力学，且未出现任何心律失常。
奥普力农对因应激性心肌病并发蛛网膜下腔出血导致的严重急性心力衰竭伴心源性休克有效。对于应激性心肌病患者，应尽可能避免使用儿茶酚胺类药物。磷酸二酯酶III抑制剂可能对应激性心肌病引起的心源性休克有用。
