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“Brain-heart crosstalk” is being increasingly recognized in the acute phase after severe brain injury. Neurogenic stunned myocardium, also called ‘neurogenic stress cardiomyopathy’ (NSC), is a syndrome that can occur after severe acute neurologic injury (i.e. SAH, TBI, ischemic or hemorrhagic stroke, CNS infections, epilepsy, or any sudden stressful neurologic event).
NSC is part of the stress-related cardiomyopathy syndrome spectrum, which includes Takotsubo syndrome. However, NSC refers specifically to myocardial dysfunction related to stress from catacholamine excess triggered by neurological injury, rather than emotional or physical stress. Neurocardiogenic injury from NSC is associated with an increased risk of all-cause mortality, cardiac mortality and heart failure.
Cardiac involvement can be appreciated with ECG changes and echocardiography. ECG changes include QT interval prolongation (large T waves & U waves), long QT syndrome & torsade de points, ST-segment depression, T-wave inversion, and ventricular & supraventricular arrhythmias. Importantly, NSC can also mimic acute myocardial infarction with LV wall motion abnormalities, and elevated cardiac biomarkers/BNP.
Emergency physicians should be aware of the diagnostic challenges posed by NSC, and maintain a high index of suspicion when admitting a patient with an unclear clinical picture. NSC management is mainly supportive and symptomatic, based on treatment of life threatening events (i.e. malignant arrhythmias or cardiogenic shock). See references to learn more about the pathophysiology and treatment options.
References
- Mazzeo AT, Micalizzi A, Mascia L, et al. Brain-heart crosstalk: the many faces of stress-related cardiomyopathy syndromes in anaesthesia and intensive care. British Journal of Anaesthesia. 2014;112(5):803–815. PMID:24638232
- Samuels MA. The Brain-Heart Connection. Circulation. 2007;116(1):77–84. PMID:17606855
- For a great case, check out “Voodoo Death”: The Deadly Brain-Heart Syndrome" recently posted on the Maryland CC Project
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