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Anesth Analg 2005;100:1147-1149
© 2005 International Anesthesia Research Society
doi: 10.1213/01.ANE.0000147704.90285.2A

NEUROSURGICAL ANESTHESIA

Delayed Cardiogenic Shock and Acute Lung Injury After Aneurysmal Subarachnoid Hemorrhage

Ives de Chazal, MD, William M. Parham, III, MD, Panayota Liopyris, MD, and Eelco F. M. Wijdicks, MD

Division of Critical Care and Division of Critical Care Neurology, Mayo Medical Center, Saint Marys Hospital, Rochester, Minnesota

Address correspondence and reprint requests to Eelco FM Wijdicks, MD, Department of Neurology, 200 First Street SW, Rochester, MN 55901. Address e-mail to wijde{at}mayo.edu.

Both cardiac and lung injury after aneurysmal subarachnoid hemorrhage has been attributed to an adrenergic surge. Cardiogenic shock is very uncommon. We describe a 55-yr-old woman with a delayed cardiogenic shock emerging within hours after aneurysmal rupture. Cardiac damage was documented by increased serum troponin T, CPK-mb fraction, and severe wall motion abnormality, which included an akinetic apex on echocardiography (ejection fraction of 33%). Her coronary angiogram was normal. Decreased cardiac index, increased systemic and pulmonary vascular resistance indices, and persistent oxygen desaturation despite improving ventricular contractility documented both cardiac and pulmonary injury. After treatment with dobutamine and milrinone all manifestations resolved.




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Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2005 by the International Anesthesia Research Society.