Zusammenfassung
Eine 34-jährige Patientin wurde nach erfolgreicher kardiopulmonaler Reanimation im kardiogenen Schock vorstellig. Fremdanamnestisch wurde eine Migräne angegeben. Die Notfallechokardiographie zeigte eine eingeschränkte linksventrikuläre Pumpfunktion mit basomittventrikulärer Hypokinesie und apikaler Hyperkontraktilität. Die kraniale Computertomographie ergab den Hinweis auf eine stattgefundene massive Subarachnoidalblutung (SAB), sodass unter Berücksichtigung der Fremdanamnese (stärkste Kopfschmerzen) die Diagnose einer SAB-assoziierten umgekehrten Takotsubo-Kardiomyopathie gestellt werden konnte. Im Rahmen einer SAB sollte stets an die Assoziation von extrazerebralen Organdysfunktionen, wie das Auftreten einer invertierten Takotsubo-Kardiomyopathie, gedacht werden.
Abstract
We present a case of a 34-year-old woman with cardiogenic shock after successful resuscitation. In the medical history migraine was known. Emergency echocardiography demonstrated left ventricular dysfunction with hypokinetic basal and midventricular segments and hyperkinetic apex. Cerebral computed tomography suggested a massive subarachnoid haemorrhage (SAH) with transtentorial herniation, so that taking into account the clinical history (severe headache) the diagnosis of a SAH-associated inverted takotsubo cardiomyopathy could be made. In the case of subarachnoid haemorrhage it should be noted that extracerebral organ dysfunction, e.g. inverted takotsubo cardiomyopathy, frequently occurs.
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Danksagung
Für die freundliche Überlassung des CT-Bildmaterials bedanken sich die Autoren bei Herrn Dr. Michael Herbrik (Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinik Köln).
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G. Michels und R. Pfister geben an, dass kein Interessenkonflikt besteht.
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R. Riessen, Tübingen
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Michels, G., Pfister, R. Umgekehrte Takotsubo-Kardiomyopathie als Folge einer Subarachnoidalblutung. Med Klin Intensivmed Notfmed 111, 145–149 (2016). https://doi.org/10.1007/s00063-015-0033-z
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DOI: https://doi.org/10.1007/s00063-015-0033-z