SAH-associated myocardial injury

zzyzx

zzyzx

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I knew that myocardial injury can be associated with subarachnoid hemorrhage (ST and troponin elevations), and years ago I saw a patient with this presentation, but until reading this article I didn't realize this was so common.

(Unfortunately only the abstract is available here.)

https://www.sciencedirect.com/science/article/pii/S009917671730048X
 
"The brain-heart interaction is well recognized after neulogical insults, particularly after a SAH, and is thought to be catecholamine mediated. SAH-associated myocardial injury is a type of neurocardiac injury that involves myocardial dysfunction associated with subarachnoid bleed. Approximately one third of patients with a SAH experience this complication. SAH-associated myocardial injury is partly attributed to sudden sympathetic activation at the time of aneurysm rupture, which cause a rapid and sustained increase in serum catecholamine levels, directly damaging the heart and resulting in myocardial contraction band necrosis. Importantly, it is not associated with myocardial ischemia. Nevertheless, the subsequent myocardial cellular damage is manifested by systemic hypoperfusion, ECG changes, elevated cardiac enzymes, and wall-motion abnormalities."
 
Not very common but I've seen it a few times. Patho is similar to other catecholemine dumps like with Pheo or Cocaine overdose. Neurogenic T waves are pretty impressive on a 12 lead.
 
Can someone explain “myocardial contraction band necrosis?” I get that a sympathetic surge is believed to be the underlying cause, but why would this cause myocardial cell death? There are lots of things that can stimulate a sympathetic response, so why would it cause damage to your heart?
 
Thanks. That article says it’s a reperfusion injury due to hypercontraction. Kind of hard to picture though. You could imagine how a large dose of cocaine could cause super tachycardia and greatly increased contraction leading to ischemia. But it’s hard seeing how your own body could trigger such a response and that an otherwise healthy heart could not handle it
 
zzyzx said:
Can someone explain “myocardial contraction band necrosis?” I get that a sympathetic surge is believed to be the underlying cause, but why would this cause myocardial cell death? There are lots of things that can stimulate a sympathetic response, so why would it cause damage to your heart?
Click to expand...

Happens in Takotsubo cardiomyopathy too. Contraction band necrosis is a sign of catecholamine cardiotoxicity. Sorry if I'm repeating something from above...haven't scanned everything real well.

Free text article:

https://www.ncbi.nlm.nih.gov/pubmed/17527000
 
Apparently so. There was a recent article in the Journal of Emergency Nursing about this. Quite interesting.
 
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