TY - JOUR
T1 - Neurogenic Stunned Myocardium Progressing to Takotsubo Cardiomyopathy with Milrinone
AU - Srinivasan, Siddharth
AU - Balakrishnan, Arjun
AU - Nair, Rajesh P.
AU - Menon, Girish
N1 - Publisher Copyright:
© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited.
PY - 2025/6
Y1 - 2025/6
N2 - A 67-year-old female came with acute-onset headache and altered sensorium secondary to a ruptured right giant supraclinoid internal carotid artery aneurysm. Echocardiography revealed global wall motion abnormalities. She underwent aneurysm clipping on day 4 following ictus and her postoperative Glasgow Coma Scale (GCS) score was E 2 V T M 5. She developed an infarct in the caudate nucleus for which milrinone infusion was started. Following milrinone infusion her blood pressure dropped significantly. Despite stopping milrinone, it did not respond to noradrenaline or dopamine. Investigations revealed a troponin of 0.6 ng/mL, and electrocardiogram showed new ST-T changes in leads V 3-V 6. Echocardiography showed paradoxical apical excursion, suggestive of Takotsubo cardiomyopathy. She was started on vasopressin, her blood pressure stabilized, and noradrenaline was gradually tapered. Due to prolonged hypoperfusion, however, GCS dropped to E 2 V T M 3. Eventually, inotropes were stopped, and cardiac contractility recovered. The patient had a sudden drop in GCS on postoperative day 25 and died.
AB - A 67-year-old female came with acute-onset headache and altered sensorium secondary to a ruptured right giant supraclinoid internal carotid artery aneurysm. Echocardiography revealed global wall motion abnormalities. She underwent aneurysm clipping on day 4 following ictus and her postoperative Glasgow Coma Scale (GCS) score was E 2 V T M 5. She developed an infarct in the caudate nucleus for which milrinone infusion was started. Following milrinone infusion her blood pressure dropped significantly. Despite stopping milrinone, it did not respond to noradrenaline or dopamine. Investigations revealed a troponin of 0.6 ng/mL, and electrocardiogram showed new ST-T changes in leads V 3-V 6. Echocardiography showed paradoxical apical excursion, suggestive of Takotsubo cardiomyopathy. She was started on vasopressin, her blood pressure stabilized, and noradrenaline was gradually tapered. Due to prolonged hypoperfusion, however, GCS dropped to E 2 V T M 3. Eventually, inotropes were stopped, and cardiac contractility recovered. The patient had a sudden drop in GCS on postoperative day 25 and died.
UR - https://www.scopus.com/pages/publications/105005145273
UR - https://www.scopus.com/pages/publications/105005145273#tab=citedBy
U2 - 10.1055/s-0045-1809056
DO - 10.1055/s-0045-1809056
M3 - Article
AN - SCOPUS:105005145273
SN - 2348-0548
VL - 12
SP - 127
EP - 129
JO - Journal of Neuroanaesthesiology and Critical Care
JF - Journal of Neuroanaesthesiology and Critical Care
IS - 2
ER -