The aim of this study is to report the development of cardiac failure after subarachnoid hemorrhage (SAH) with recovery of heart and cerebral function. This is a case report of a 38-year-old woman who was admitted to the intensive care unit (ICU) at Policlinico di Modena, Italy. This woman developed a deep state of coma because of severe SAH. After cerebral hemorrhage, patient showed a cardiogenic shock, which needed invasive monitoring. Cerebral perfusion pressure had to be restored, so fluids, dopamine, norepinephrine, and dobutamine were in administered sequentially. Despite these supportive treatments, hemodynamic parameters further worsened and echocardiography showed a global depressed left ventricular (LV) contraction with poor ejection fraction (EF) and restrictive type of LV relaxation pattern. Twenty-four hours after ICU admission, levosimendan was started with the aim to improve cardiac function because of the refractoriness of all other treatments. Eight hours after levosimendan infusion, cardiac function improved and, within the after 24 hours, EF and LV relaxation pattern recovered. Neurologic state and computed tomography images improved day by day, and after 9 days from the ICU admission, we transferred the patient to the neurosurgical ward with very good neurologic conditions and no deficits in motility. The conventional management of post-SAH cardiovascular failure is based on the use of norepinephrine, dobutamine, and high amount of fluids. This strategy did not provide any improvement, so we decided for levosimendan infusion to counteract myocardial stunning. The improvement in cardiac EF, LV wall motion, and filling pressure observed in our patient could be explained due to the antistunning triple-mechanism action of levosimendan. Data available on the levosimendan effectiveness in patients with SAH and its effect on intracranial pressure are still lacking, but we think that neurogenic cardiac failure can be treated at first with levosimendan. © 2010 Lippincott Williams & Wilkins.

Levosimendan in cardiac failure after subarachnoid hemorrhage / Busani, S; Rinaldi, L; Severino, C; Cobelli, M; Pasetto, Alberto; Girardis, Massimo. - In: THE JOURNAL OF TRAUMA, INJURY, INFECTION, AND CRITICAL CARE. - ISSN 0022-5282. - STAMPA. - 68:(2010), pp. 108-110. [10.1097/TA.0b013e31817c4284]

Levosimendan in cardiac failure after subarachnoid hemorrhage.

Busani S;PASETTO, Alberto;GIRARDIS, Massimo
2010

Abstract

The aim of this study is to report the development of cardiac failure after subarachnoid hemorrhage (SAH) with recovery of heart and cerebral function. This is a case report of a 38-year-old woman who was admitted to the intensive care unit (ICU) at Policlinico di Modena, Italy. This woman developed a deep state of coma because of severe SAH. After cerebral hemorrhage, patient showed a cardiogenic shock, which needed invasive monitoring. Cerebral perfusion pressure had to be restored, so fluids, dopamine, norepinephrine, and dobutamine were in administered sequentially. Despite these supportive treatments, hemodynamic parameters further worsened and echocardiography showed a global depressed left ventricular (LV) contraction with poor ejection fraction (EF) and restrictive type of LV relaxation pattern. Twenty-four hours after ICU admission, levosimendan was started with the aim to improve cardiac function because of the refractoriness of all other treatments. Eight hours after levosimendan infusion, cardiac function improved and, within the after 24 hours, EF and LV relaxation pattern recovered. Neurologic state and computed tomography images improved day by day, and after 9 days from the ICU admission, we transferred the patient to the neurosurgical ward with very good neurologic conditions and no deficits in motility. The conventional management of post-SAH cardiovascular failure is based on the use of norepinephrine, dobutamine, and high amount of fluids. This strategy did not provide any improvement, so we decided for levosimendan infusion to counteract myocardial stunning. The improvement in cardiac EF, LV wall motion, and filling pressure observed in our patient could be explained due to the antistunning triple-mechanism action of levosimendan. Data available on the levosimendan effectiveness in patients with SAH and its effect on intracranial pressure are still lacking, but we think that neurogenic cardiac failure can be treated at first with levosimendan. © 2010 Lippincott Williams & Wilkins.
68
108
110
Levosimendan in cardiac failure after subarachnoid hemorrhage / Busani, S; Rinaldi, L; Severino, C; Cobelli, M; Pasetto, Alberto; Girardis, Massimo. - In: THE JOURNAL OF TRAUMA, INJURY, INFECTION, AND CRITICAL CARE. - ISSN 0022-5282. - STAMPA. - 68:(2010), pp. 108-110. [10.1097/TA.0b013e31817c4284]
Busani, S; Rinaldi, L; Severino, C; Cobelli, M; Pasetto, Alberto; Girardis, Massimo
File in questo prodotto:
File Dimensione Formato  
Pasetto3.pdf

non disponibili

Tipologia: Post-print dell'autore (bozza post referaggio)
Dimensione 569.23 kB
Formato Adobe PDF
569.23 kB Adobe PDF   Visualizza/Apri   Richiedi una copia
Pubblicazioni consigliate

Caricamento pubblicazioni consigliate

Licenza Creative Commons
I metadati presenti in IRIS UNIMORE sono rilasciati con licenza Creative Commons CC0 1.0 Universal, mentre i file delle pubblicazioni sono rilasciati con licenza Attribuzione 4.0 Internazionale (CC BY 4.0), salvo diversa indicazione.
In caso di violazione di copyright, contattare Supporto Iris

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11380/727854
Citazioni
  • ???jsp.display-item.citation.pmc??? 7
  • Scopus 27
  • ???jsp.display-item.citation.isi??? 28
social impact