Norepinephrine
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Inverted Takotsubo cardiomyopathy: case report A 22-year-old female trauma patient developed inverted Takotsubo cardiomyopathy during treatment with norepinephrine. The woman was admitted to an ICU with severe trauma, including severe head injury. She presented intracranial hypertension, which was initially treated with sedation, muscle relaxation and osmotherapy; however, a pericontusional brain oedema was noted on hospital day 4, and she began receiving additional norepinephrine [noradrenaline] 0.8–1 µg/kg/min to increase her cranial perfusion pressure to > 65mm Hg; at that time, she had a pulmonary artery pressure of 39/20mm Hg, a pulmonary capillary wedge pressure of 17mm Hg, and a cardiac output of 3.5 L/min. On hospital day 5, an ECG showed sinus tachycardia of 140 beats/min, a subepicardial injury pattern in leads I, aVL, and V5–V6, and a subendocardial injury pattern in anteroseptal and inferior leads. Moderate to severe left ventricular (LV) dysfunction was evident on echocardiography, as were marked basal and midventricular hypokinesia; apical contraction was preserved. The woman underwent emergent coronary angiography, which revealed normal coronary arteries. However, a left ventriculogram confirmed persistent LV dysfunction. Her peak CK and troponin I levels, and CK-MB fraction were 242 U/L, 1.13 ng/mL and 3%, respectively. Her norepinephrine infusion rate was decreased, and dobutamine was added with improvement of her intracranial hypertension. At that time, she had a cardiac output of 5.7 L/min. A repeat ECG was normal on day 7, and improvement of LV systolic function, as well as mild basal hypokinesia, was evident on echocardiogram. Her intracranial pressure had normalised on day 12, she became conscious and was extubated. Author comment: "In our patient, we speculate that the use of catecholamines to improve cerebral perfusion pressure could have played a deleterious role on cardiac function" RIERA M, et al. Head injury and inverted Takotsubo cardiomyopathy. Journal of Trauma - Injury, Infection, and Critical Care 68: E13-5, No. 1, Jan 2010 803006879 Spain
0114-9954/10/1291-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Reactions 6 Mar 2010 No. 1291
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