Neurogenic Stunned Myocardium in Severe Neurological Injury

• Published in: Current neurology and neuroscience reports Vol. 19; no. 11; pp. 90 - 9
• Main Authors: Kenigsberg, Benjamin B., Barnett, Christopher F., Mai, Jeffrey C., Chang, Jason J.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.11.2019; Springer Nature B.V
• Subjects: Acute coronary syndromes; Cardiomyopathy; Critical Care (Stephan A. Mayer; Diagnosis; Echocardiography; EKG; Epidemiology; Heart transplantation; Heart transplants; Medicine; Medicine & Public Health; Myocardium; Neurology; Neurosciences; Pathophysiology; Section Editor; Topical Collection on Critical Care; Toxicity; Neurogenic stunned myocardium; Takotsubo cardiomyopathy; Severe traumatic brain injury; Stress cardiomyopathy; Subarachnoid hemorrhage
• ISSN: 1528-4042; 1534-6293
• DOI: 10.1007/s11910-019-0999-7

Purpose of Review Neurogenic stunned myocardium (NSM) is a poorly recognized cardiac manifestation of neurological illness. This review addresses the contemporary understanding of NSM pathophysiology, epidemiology, diagnosis, and clinical management. Recent Findings While the precise pathophysiology and diagnosis remain unclear, NSM is phenotypically atypical stress cardiomyopathy that can be partially attributed to excess catecholaminergic toxicity. NSM is a diagnosis of exclusion where electrocardiography, echocardiography, and cardiac biomarkers are frequently abnormal. Clinical expertise is crucial to evaluate and differentiate NSM from acute coronary syndrome and in the evaluation of potential cardiac transplantation donors after unsalvageable severe neurological injury. Summary Neurogenic stunned myocardium is a relatively common and clinically impactful condition. More research is needed, particularly to refine clinical prognostication of NSM and rule out intrinsic cardiac injury in order to optimize donor candidacy in the event of brain death.