Clinical Management of Neurogenic Mediated Cardiomyopathy in Children
CCCF ePoster library. Smith R. Oct 31, 2016; 150906; 28 Disclosure(s): No Disclosure
Dr. Rebecca Smith
Dr. Rebecca Smith
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Topic: Clinical Case Report

Clinical Management of Neurogenic Mediated Cardiomyopathy in Children

Smith, Rebecca1; Zoica, Bogdana1; Kulkarni, Abhaya2; Annich, Gail1

1 Paediatric Critical Care, Hospital for Sick Children, Toronto, Canada
2 Department of Neurosurgery, Hospital for Sick Children, Toronto, Canada



 Introduction: Cardiac dysfunction is well-recognized following acute catastrophic intracerebral events, classically described in adults with subarachnoid hemorrhage. In the pediatric population only a few cases have been described. There is growing interest in this entity as pediatric reports emerge. The incidence and pathophysiology in the pediatric population remain unclear. We present two recent cases of stress cardiomyopathy following an acute neurologic event. We aim to highlight the unique challenges of managing a failing heart whilst maintaining cerebral perfusion.
Case 1 describes a 6 year old male with a bleeding cerebral arterio-venous malformation and cardiogenic shock. Attempts to improve brain perfusion with inotrope support resulted in further deterioration in hemodynamics. Bedside echo showed acute severe left ventricular dysfunction with an ejection fraction of 20%. Hemodynamic stabilization was achieved after coiling of the aneurysm. Complete recovery of cardiac function was seen on day 5. He was discharged to a rehabilitation service and at 3 months follow up was walking with support despite residual left sided weakness.
Case 2 describes a 12 year old male post debulking of an acute posterior fossa bleed secondary to underlying tumor. During the surgical intervention he became increasingly difficult to ventilate and received escalating doses of vasopressor support to maintain blood pressure. On arrival to the critical care unit he was noted to have pulmonary edema and hypotension. Acute bedside echo showed severe left ventricular dysfunction with an ejection fraction of 25%. Hemodynamics improved following a change in inotrope strategy. His echo had normalized by day 6 of admission. He was discharged to a rehabilitation service walking with support, with normal speech and cognitive function.
Conclusion: We believe neurogenic mediated myocardial dysfunction in pediatric intensive care is under-recognized but clinically important. Maintaining adequate cerebral perfusion to prevent further insult is the mainstay in the acute management of brain injury. In the setting of concurrent acute cardiac failure this becomes challenging as interventions to support the myocardium can be opposite to those required to support cerebral perfusion. Early recognition of this condition is paramount to optimizing the support of both the brain and the heart. Typically, if this can be achieved, the cardiac dysfunction is transient and the neurologic outcome can be promising.


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