Ampulla (takotsubo) cardiomyopathy can occur and worsen in the late phase of vasospasm following subarachnoid hemorrhage, necessitating careful management of heart function and fluid balance.
May require extended cardiac monitoring during SAH vasospasm; single case leaves open need for prospective validation.
A 66-year-old woman presented with subarachnoid hemorrhage(SAH) caused by a ruptured aneurysm of the left middle cerebral artery. Electrocardiography (ECG) disclosed abnormalities resembling acute myocardial infarction. She underwent neck clipping of the aneurysm uneventfully. Sixteen days after admission, ECG again disclosed abnormalities resembling acute myocardial infarction, and echocardiography suggested heart failure. Coronary angiography showed no abnormalities, but left ventriculography showed severe hypokinesia in the apex of the heart consistent with so-called ampulla (takotsubo) cardiomyopathy. The heart failure was treated with catecholamines and her heart function gradually recovered. Ampulla (takotsubo) cardiomyopathy associated with SAH requires careful management of heart function.
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Ono et al. (2004) studied this question.
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