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Cardiogenic Shock with Stunned Myocardium during Triple-H Therapy Treated with Intra-aortic Balloon Pump Counterpulsation

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Abstract

Introduction

Excessive use of adrenergic agents may result in stunned myocardium.

Cases

We report the cases of two patients with subarachnoid hemorrhage (SAH) complicated by cardiogenic shock secondary to triple-H therapy for cerebral vasospasm. Both patients had normal cardiac function on admission and no signs of acute myocardial infarction at the onset of cardiogenic shock. Intra-aortic balloon pump (IABP) counterpulsation was used to maintain adequate cerebral perfusion while enabling the high doses of norepinephrine that were being administered to be reduced. Reversal of the myocardial dysfunction after vasopressors were discontinued supported a diagnosis of catecholamine-induced stunned myocardium.

Conclusion

IABP counterpulsation may be one therapeutic option for patients with vasospasm after SAH when high doses of vasopressors can induce severe myocardial dysfunction. However, this invasive device may not be sufficient to maintain adequate cerebral perfusion and fatal embolic events can complicate the clinical course.

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Authors and Affiliations

  1. Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik, 808, 1070, Brussels, Belgium

    Fabio Silvio Taccone, Michael Piagnerelli, Marc Van Nuffelen, Jean-Louis Vincent & Daniel De Backer

  2. Department of Neuro-Radiology, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik, 808, 1070, Brussels, Belgium

    Boris Lubicz

Authors
  1. Fabio Silvio Taccone
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  2. Boris Lubicz
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Correspondence to Fabio Silvio Taccone.

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Taccone, F.S., Lubicz, B., Piagnerelli, M. et al. Cardiogenic Shock with Stunned Myocardium during Triple-H Therapy Treated with Intra-aortic Balloon Pump Counterpulsation. Neurocrit Care 10, 76–82 (2009). https://doi.org/10.1007/s12028-008-9135-2

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  • DOI: https://doi.org/10.1007/s12028-008-9135-2

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