The problem of neurogenic stunned myocardium in the intensive care practice

M.D. Bitchuk


The purpose of the review is to assess the prevalence of neurogenic stunned myocardium (SM), to determine the main pathological mechanisms of its formation and the principles of intensive care. Neurogenic SM is a condition characterized by a significant decrease in the pumping function of the heart in patients with neurological and neurosurgical disorders without acute myocardial necrosis. The greatest number of observations of SM phenomenon is described among patients with subarachnoid he-morrhage, traumatic brain injury, Guillain-Barre syndrome. The term “neurogenic SM” may be associated with cerebral-cardiac syndrome, as well as with other terms known as stress-induced cardiomyopathy, apical ballooning syndrome, ampulla cardiomyopathy, broken heart syndrome. Heart Failure Association of the European Society of Cardiology currently considers neurogenic SM as a particular case of takotsubo syndrome. The development of SM is associated with the adverse effect of the massive release of catecholamines into the blood under severe stress conditions, calcium overload of cardiomyocytes, excessive activation of free radical oxidation processes. The most severe clinical manifestations of SM are cardiogenic shock and centrogenic pulmonary edema. The most common and available methods for the clinical diagnosis of SM are electrocardiographic monitoring, detailed transthoracic ultrasound of the heart, transpulmonary thermodilution, and the determination of a moderate increase in the plasma concentration of cardiac troponins. Respiratory support and drugs with a positive inotropic effect are widely used as part of intensive care measures for neurogenic SM.


neurogenic stunned myocardium; stress; catecholamines; cerebral stroke; severe traumatic brain injury; central hemodynamics; cardiogenic shock; cardiac troponins; review


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