Cardiac dysfunction evoked by ECG and echocardiography changes and release of cardiac biomarkers in patients with aneurysmal subarachnoid haemorrhage.: Case presentation and literature review

Abstract

The invisible brain-heart link has been observed and described for centuries now, although a greater interest in the matter has been manifested over the past several decades, especially in patients with aneurysmal subarachnoid haemorrhage (aSAH). We present the case of a patient with aSAH and signs of cardiac injury evoked by ECG changes and elevated cardiac enzymes. Furthermore, we reviewed current medical literature by searching the international database PubMed for recent articles on the subject of cardiac biomarkers, ECG and echocardiography changes in the setting of SAH. Our analysis of the selected articles, published between 2012 and 2018, revealed that 22 are patient population studies, 16 are case studies and 6 are reviews of the literature. The most common ECG changes were prolonged QTc andnonspecific ST/T-wave changes. Echocardiography changes included regional wall-motion abnormalities, typically involving the base of the heart (neurogenic stunned myocardium), yet there was also the scenario of Takotsubo cardiomyopathy (stress cardiomyopathy), which affects the apex of the heart. There is a significant statistical association of elevated levels of troponin and NT-proBNP with a bad outcome after SAH, and we should always keep in mind the dramatic scenario of misdiagnosing the cerebral haemorrhage and treating for a coronary syndrome instead. Therefore, the management of aSAH requires a close cooperation between neurosurgeons, intensivists, cardiologists and radiologists in high volume centres.