Diagnosis and Management of Takotsubo Syndrome in Acute Aneurysmal Subarachnoid Hemorrhage: A Comprehensive Review
Takotsubo syndrome (TS) is a frequent complication of subarachnoid hemorrhage (SAH), especially in massive SAH with severe neurological damage. The initial presentation of TS is similar to acute coronary syndrome, causing differential diagnostic issues. Unnecessary diagnostic steps and uncertainty i...
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| Format: | Article |
| Language: | English |
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IMR Press
2023-06-01
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| Series: | Reviews in Cardiovascular Medicine |
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| Online Access: | https://www.imrpress.com/journal/RCM/24/6/10.31083/j.rcm2406177 |
| _version_ | 1797792725066579968 |
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| author | Dorottya Szántó Péter Luterán Judit Gál Endre V. Nagy Béla Fülesdi Csilla Molnár |
| author_facet | Dorottya Szántó Péter Luterán Judit Gál Endre V. Nagy Béla Fülesdi Csilla Molnár |
| author_sort | Dorottya Szántó |
| collection | DOAJ |
| description | Takotsubo syndrome (TS) is a frequent complication of subarachnoid hemorrhage (SAH), especially in massive SAH with severe neurological damage. The initial presentation of TS is similar to acute coronary syndrome, causing differential diagnostic issues. Unnecessary diagnostic steps and uncertainty in therapy may delay the definitive treatment of the aneurysm, therefore increasing the risk of rebleeding. The purpose of this review is to summarize the latest knowledge on the diagnosis and therapy of TS in SAH and to provide a diagnostic and therapeutic algorithm for the acute phase, promoting the early definitive treatment of the aneurysm. Rapid hemodynamic stabilization and early aneurysm securing are key points in reducing the risk of delayed cerebral ischemia and improving outcomes. In acute SAH noninvasive bedside diagnostic methods are preferred and securing the aneurysm is the priority. The combination of electrocardiography, cardiac biomarkers, and echocardiography is of great importance in differentiating TS from acute myocardial infarction. The risk-benefit ratio of coronary angiography should be carefully and individually considered and its use should be limited to patients with strong evidence of myocardial ischemia, after the successful endovascular treatment of the aneurysm. Invasive hemodynamic monitoring may be beneficial in cases of cardiogenic shock or pulmonary edema. In patients with hemodynamical instability secondary to TS, the use of non-catecholamine inotropes, especially levosimendan is recommended. In refractory hypotension, mechanical support should be considered. The left ventricular function improves within days to months after the acute event, low initial ejection fraction may predispose to delayed recovery. |
| first_indexed | 2024-03-13T02:36:56Z |
| format | Article |
| id | doaj.art-fdda14be3ae74100bff3657434a8461f |
| institution | Directory Open Access Journal |
| issn | 1530-6550 |
| language | English |
| last_indexed | 2024-03-13T02:36:56Z |
| publishDate | 2023-06-01 |
| publisher | IMR Press |
| record_format | Article |
| series | Reviews in Cardiovascular Medicine |
| spelling | doaj.art-fdda14be3ae74100bff3657434a8461f2023-06-29T02:06:46ZengIMR PressReviews in Cardiovascular Medicine1530-65502023-06-0124617710.31083/j.rcm2406177S1530-6550(23)01001-3Diagnosis and Management of Takotsubo Syndrome in Acute Aneurysmal Subarachnoid Hemorrhage: A Comprehensive ReviewDorottya Szántó0Péter Luterán1Judit Gál2Endre V. Nagy3Béla Fülesdi4Csilla Molnár5Department of Anesthesiology and Intensive Care, Faculty of Medicine, University of Debrecen, 4032 Debrecen, HungaryDepartment of Anesthesiology and Intensive Care, Faculty of Medicine, University of Debrecen, 4032 Debrecen, HungaryDepartment of Anesthesiology and Intensive Care, Faculty of Medicine, University of Debrecen, 4032 Debrecen, HungaryDepartment of Internal Medicine, Faculty of Medicine, University of Debrecen, 4032 Debrecen, HungaryDepartment of Anesthesiology and Intensive Care, Faculty of Medicine, University of Debrecen, 4032 Debrecen, HungaryDepartment of Anesthesiology and Intensive Care, Faculty of Medicine, University of Debrecen, 4032 Debrecen, HungaryTakotsubo syndrome (TS) is a frequent complication of subarachnoid hemorrhage (SAH), especially in massive SAH with severe neurological damage. The initial presentation of TS is similar to acute coronary syndrome, causing differential diagnostic issues. Unnecessary diagnostic steps and uncertainty in therapy may delay the definitive treatment of the aneurysm, therefore increasing the risk of rebleeding. The purpose of this review is to summarize the latest knowledge on the diagnosis and therapy of TS in SAH and to provide a diagnostic and therapeutic algorithm for the acute phase, promoting the early definitive treatment of the aneurysm. Rapid hemodynamic stabilization and early aneurysm securing are key points in reducing the risk of delayed cerebral ischemia and improving outcomes. In acute SAH noninvasive bedside diagnostic methods are preferred and securing the aneurysm is the priority. The combination of electrocardiography, cardiac biomarkers, and echocardiography is of great importance in differentiating TS from acute myocardial infarction. The risk-benefit ratio of coronary angiography should be carefully and individually considered and its use should be limited to patients with strong evidence of myocardial ischemia, after the successful endovascular treatment of the aneurysm. Invasive hemodynamic monitoring may be beneficial in cases of cardiogenic shock or pulmonary edema. In patients with hemodynamical instability secondary to TS, the use of non-catecholamine inotropes, especially levosimendan is recommended. In refractory hypotension, mechanical support should be considered. The left ventricular function improves within days to months after the acute event, low initial ejection fraction may predispose to delayed recovery.https://www.imrpress.com/journal/RCM/24/6/10.31083/j.rcm2406177takotsubo syndromesubarachnoid hemorrhageneurogenic stunned myocardiumdelayed cerebral ischemiaintracranial aneurysm treatment |
| spellingShingle | Dorottya Szántó Péter Luterán Judit Gál Endre V. Nagy Béla Fülesdi Csilla Molnár Diagnosis and Management of Takotsubo Syndrome in Acute Aneurysmal Subarachnoid Hemorrhage: A Comprehensive Review Reviews in Cardiovascular Medicine takotsubo syndrome subarachnoid hemorrhage neurogenic stunned myocardium delayed cerebral ischemia intracranial aneurysm treatment |
| title | Diagnosis and Management of Takotsubo Syndrome in Acute Aneurysmal Subarachnoid Hemorrhage: A Comprehensive Review |
| title_full | Diagnosis and Management of Takotsubo Syndrome in Acute Aneurysmal Subarachnoid Hemorrhage: A Comprehensive Review |
| title_fullStr | Diagnosis and Management of Takotsubo Syndrome in Acute Aneurysmal Subarachnoid Hemorrhage: A Comprehensive Review |
| title_full_unstemmed | Diagnosis and Management of Takotsubo Syndrome in Acute Aneurysmal Subarachnoid Hemorrhage: A Comprehensive Review |
| title_short | Diagnosis and Management of Takotsubo Syndrome in Acute Aneurysmal Subarachnoid Hemorrhage: A Comprehensive Review |
| title_sort | diagnosis and management of takotsubo syndrome in acute aneurysmal subarachnoid hemorrhage a comprehensive review |
| topic | takotsubo syndrome subarachnoid hemorrhage neurogenic stunned myocardium delayed cerebral ischemia intracranial aneurysm treatment |
| url | https://www.imrpress.com/journal/RCM/24/6/10.31083/j.rcm2406177 |
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