Aneurysmal subarachnoid hemorrhage as a trigger for Takotsubo syndrome: a comprehensive review

Rev Cardiovasc Med. 2021 Dec 22;22(4):1241-1251. doi: 10.31083/j.rcm2204132.

Abstract

Takotsubo syndrome (TTS) can result in acute heart failure and lead to a potentially life-threatening complication of aneurysmal subarachnoid hemorrhage (aSAH). The incidence of TTS in aSAH is less than 10% of all patients with aSAH, with a preponderance of postmenopausal women. Early indicators of TTS include elevated serum troponin levels and electrocardiographic abnormalities. The key finding is left ventricular wall motion abnormality. Echocardiography and coronary angiography help to establish the diagnosis. Vasopressors, milrinone, levosimendan, insulin, and anticoagulation may be required. The value of beta-blockers is a matter of controversy. TTS must not delay the treatment of a ruptured aneurysm. The clinical outcome in patients with aSAH and TTS is mostly determined by the aSAH and not the TTS.

Keywords: Broken heart syndrome; Intracranial aneurysm rupture; Myocardial stunning; Neurogenic stunned myocardium; Subarachnoid hemorrhage; Sympathetic disruption syndrome; Takotsubo syndrome.

Publication types

  • Review

MeSH terms

  • Adrenergic beta-Antagonists / therapeutic use
  • Echocardiography
  • Female
  • Humans
  • Subarachnoid Hemorrhage* / diagnosis
  • Subarachnoid Hemorrhage* / diagnostic imaging
  • Takotsubo Cardiomyopathy* / diagnosis
  • Takotsubo Cardiomyopathy* / epidemiology
  • Takotsubo Cardiomyopathy* / therapy
  • Troponin

Substances

  • Adrenergic beta-Antagonists
  • Troponin