Case reports
Reversible left ventricular dysfunction associated with raised
troponin I after subarachnoid haemorrhage does not preclude successful
heart transplantation
E Deibert, V Aiyagari, M N Diringer
Neurology/Neurosurgery
Intensive Care Unit, Department of Neurology, Box 8111, Washington
University School of Medicine, 660 South Euclid Avenue, St Louis,
MO 63110, USA
Correspondence to: Dr Ellen Deibert email: deiberte{at}neuro.wustl.edu
Accepted 23 March 2000
Transient abnormalities in ECGs,
echocardiograms, and cardiac enzymes have been described in the acute
setting of subarachnoid haemorrhage. In addition, left ventricular
dysfunction has been reported at the time of brain death. A patient
with an acute subarachnoid haemorrhage who presented with raised
troponin I (TnI) concentrations and diffuse left ventricular
dysfunction is described. After declaration of brain death 32 hours
later, the heart was felt initially not suitable for transplantation. A
normal cardiac catheterisation, however, lead to successful
transplantation of the donor heart. Raised catecholamine concentrations
and metabolic perturbations have been proposed as the mechanisms
leading to the cardiac dysfunction seen with brain death. This may be a
biphasic process, allowing time for myocardial recovery and reversal of
the left ventricular dysfunction. Awareness of this phenomenon in the
acutely ill neurologic population needs to be raised in order to
prevent the unnecessary rejection of donor hearts.
Keywords: heart transplantation; troponin I; left ventricular dysfunction
© 2000 by Heart
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