Delayed Cardiogenic Shock and Acute Lung Injury After Aneurysmal Subarachnoid Hemorrhage

In Brief Both cardiac and lung injury after aneurysmal subarachnoid hemorrhage has been attributed to an adrenergic surge. Cardiogenic shock is very uncommon. We describe a 55-yr-old woman with a delayed cardiogenic shock emerging within hours after aneurysmal rupture. Cardiac damage was documented by increased serum troponin T, CPK-mb fraction, and severe wall motion abnormality, which included an akinetic apex on echocardiography (ejection fraction of 33%). Her coronary angiogram was normal. Decreased cardiac index, increased systemic and pulmonary vascular resistance indices, and persistent oxygen desaturation despite improving ventricular contractility documented both cardiac and pulmonary injury. After treatment with dobutamine and milrinone all manifestations resolved. IMPLICATIONS: Cardiac injury after subarachnoid hemorrhage is common. However, when cardiogenic shock occurs, definitive management of the aneurysm is often deferred. In our patient, the delayed onset of severe cardiac injury, cardiogenic shock with normal coronary arteries, and neurogenic pulmonary edema were all remarkable features, as was the capacity for full cardiac recovery.