SACGR

November 3, 2005

26 year old woman with SAHInitially presented with strep viridans bacteremia

Developed cardiogenic shock, right cerebral stroke with a CT scan showing multiple cerebral emboli, and an echocardiogram showed a completely “destroyed mitral valve with huge vegetations actually cascading up onto the left atrial wall “

Received bioprosthetic mitral valve

Later developed 3rd degree heart block and received pacer

Did well until severe headache, found to be 1 cm basilar tip aneurysm

Went for coiling, developed sudden severe headache, fresh blood in ventricular drain, & apnea and was emergently intubated

Stabilized but later develops vasospasm, pressors started to maintain systolic BP greater than 140

More Information

• Past Medical History– Hepatitis C

• Medications– None

• Habits– All bad

• Social History– Mother of two, husband in Iraq

More Information

• Afebrile BP 113/72 HR 80 AC 10/14 600 .3 5

• Sedated, not following commands

• Coarse bilaterally, sternal incision

• 7.36/37/110

Effects of Phenylephrine

Reinelt H, Radermacher P, Kiefer P, Fischer G, Wachter U, Vogt J, Georgieff M. Impact of exogenous beta-adrenergic receptor stimulation on

hepatosplanchnic oxygen kinetics and metabolic activity in septic shock. Crit Care Med. 1999 Feb;27(2):325-31.

Risks for Cardiac Dysfunction

Tung P, Kopelnik A, Banki N, Ong K, Ko N, Lawton MT, Gress D, Drew B, Foster E, Parmley W, Zaroff J. Predictors of neurocardiogenic injury after subarachnoid hemorrhage. Stroke. 2004 Feb;35(2):548-51.

Risks for Cardiac Dysfunction

Tung P, Kopelnik A, Banki N, Ong K, Ko N, Lawton MT, Gress D, Drew B, Foster E, Parmley W, Zaroff J. Predictors of neurocardiogenic injury after subarachnoid hemorrhage. Stroke. 2004 Feb;35(2):548-51.

Hunt and Hess

Risks for Cardiac Dysfunction

Tung P, Kopelnik A, Banki N, Ong K, Ko N, Lawton MT, Gress D, Drew B, Foster E, Parmley W, Zaroff J. Predictors of neurocardiogenic injury after subarachnoid hemorrhage. Stroke. 2004 Feb;35(2):548-51.

Risks for Cardiac Dysfunction

Macrea LM, Tramer MR, Walder B. Spontaneous subarachnoid hemorrhage and serious cardiopulmonary dysfunction--a systematic review. Resuscitation. 2005 May;65(2):139-48.

http://blog.hsl.washington.edu/chest/