Page 96 - Cardiac abnormalities after aneurysmal subarachnoid hemorrhage

Chapter 7
This thesis centers on the cardiac abnormalities that are associated with aneurysmal subarachnoid hemorrhage (aSAH). It is based on two observations: 1. The notion that cardiac abnormalities occur frequently after aneurysmal subarachnoid hemorrhage (aSAH) and that they might worsen clinical outcome; 2. The notion that stress cardiomyopathy, “The broken heart syndrome” or Tako-tsubo cardiomyopathy is increasingly being reported after several forms of acute physical or emotional stress and that it has striking similarities with the cardiac abnormalities observed after aSAH.
Stress induced cardiac abnormalities, which may mimic an acute coronary syndrome and predominantly occur in postmenopausal women, present with ECG changes, left ventricular dysfunction and cardiac specific serum enzyme- and protein elevation (CK-MB, Troponins, and NT-proBNP). Typically, there is absence of obstructive coronary artery disease. The characteristic echocardiographic finding is an aneurysmal apex with a hyperdynamic base, which resembles the shape of a Japanese octopus trap called Tako-tsubo (in Japanese Tako means octopus and Tsubo means trap, see figure 1), hence the name Tako-Tsubo cardiomyopathy.
Figure 1: Japanese octopus trap or Takotsubo. The octopus swims into the pot that lies on the ocean floor with food in it. The octopus cannot swim out because of the narrow neck. Courtesy of prof. Yoshihiro Akashi, Hiroshima for providing the Takotsubo. Photo made by me.
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