Takotsubo cardiomyopathy in aneurysmal subarachnoid hemorrhage: Institutional experience and literature review

• TCM increases the mortality rate of SAH.
• The use of vasopressors in TCM to treat vasospasm is not contraindicated and was associated with overall better outcome in our patient population.
• The use of beta blockers was not associated with significant difference in outcome in our patients.
• Anesthesia and surgical clipping of aneurysms is safe in patients with TCM and SAH.
• Swan Ganz catheter has a limited use in monitoring patients with TCM.

ObjectivesTo review the current practice in the diagnosis, monitoring and management of TCM in SAH patients at our tertiary referral institution and the relevant literature, and to evaluate the effect of certain treatment modalities on the outcome of those patients.Patients and methodsA retrospective institutional chart review of 800 patients with aneurysmal SAH from 2007 to 2014. Eighteen patients were identified to have both aneurysmal SAH and TCM based on echocardiogram. Demographic data, clinical parameters, radiographic findings, treatment modalities, and laboratory results were analyzed.ResultsThe incidence of typical TCM in our patients was 2.2%. Mortality rate of TCM in SAH was 22% compared to the total mortality rate of all non-traumatic SAH patients of 15% in our institution over the same time period. Use of beta blockers prior to or after the diagnosis of TCM did not seem to affect their outcome. Majority of patients (61%) were on vasopressors prior to the diagnosis of TCM. Of those, 73% had good outcomes. Even after the diagnosis of TCM, good outcomes were observed in 6 of 7 patients who remained on vasopressors.ConclusionDespite the general agreement on the importance of the avoidance of vasopressors in TCM, our experience showed that the use of vasopressors is safe in these patients. The use of beta blockers in our patients was not associated with significantly better outcomes despite multiple previous reports on beta blocker usage in TCM.