STRESS-RELATED CARDIOMYOPATHY SYNDROMES IN ANESTHESIA AND INTENSIVE CARE

Abstract

SUMMARY I ntense brain–heart crosstalk is increasingly recognized in the acute phase after severe brain injury, Neurogenic stress cardiomyopathy (NSC) being the best known clinical life-threatening expression. Takotsubo cardiomyopathy is a type of neurocardiological disorder that manifests as acute but reversible heart failure. Recent research has focused on how to identify, at an early stage, patients at risk of developing NSC after acute brain injury and how to protect them. Adequate screening and monitoring of cardiovascular function should be considered at the time of admission of these patients and careful re-evaluation planned accordingly. Excess catecholamine related to physical andemotional distress seems to play a major role in the pathogenesis of this cardiomyopathy.Stress-induced cardiomyopathy is an increasingly reported syndrome characterized by transient apical LV dysfunction in the absence of significantcoronary artery disease. Common presenting features include ECG abnormalities,elevated cardiac biomarkers, chest pain and dyspnea. Acute complications of stress-induced cardiomyopathy include tachyarrhythmias, bradyarrhythmias, pulmonary edema, cardiogenic shock and transient LVOT obstruction. The initial management of stress-induced cardiomyopathy, include hydration and an attempt to alleviate the triggering physical or emotional stress. Combined alpha and betaadrenoceptor blockade might therefore mitigate the syndrome. Supplementation of estrogen in postmenopausal women might protect against its development. The prognosis is good in patients who survive without complications.