ABSTRACT
At present, the heart of donor from donation after brain death are the primary organ sources for heart transplantation. After brain death, severe hemodynamic changes and a series of organ functional changes will occur, thereby leading to the functional damage or even loss of tissues and organs, especially the heart. Intimate relationship and interaction have been found in the physiology and pathophysiology between nervous and cardiovascular systems. After stroke, autonomic nervous disorder, neuroendocrine disorder and intense and persistent inflammatory reaction could be caused by the brain-heart axis reaction, leading to stroke-induced cardiac injuries, such as sympathetic storm, catecholamine storm, inflammatory storm, etc. In this article, research progresses on the mechanism of myocardial injury in heart from donors with stroke and the effect on clinical efficacy and prognosis after heart transplantation were reviewed, aiming to provide reference for clinical practice and subsequent research.
Subject(s)
Humans , Diffuse Axonal Injury , Epilepsy , Primary Dysautonomias , Brain Injuries, TraumaticABSTRACT
Objective To explore the efficacy and safety of esmolol for the treatment of acute myocardial infarction patients with sympathetic storm.Methods Sixty acute myocardial infarction patients who suffered from sympathetic storm during the hospitalization from January 2013 to January 2015 in the People's Hospital of Baoji City.The patients were randomly divided into two groups : esmolol group(patients were treated with cardioversion or electric defibrillation and esmolol, n =30) and control group (patients were treated with cardioversion or electric defibrillation and amiodarone, n =30).Results The effective rate of esmolol group was 93.33％ (28/30), of control group was 70.00％ (21/30), and the difference was significant (x2 =5.455, P =0.020).The success rate of esmolol group which terminated sympathetic storm was significantly higher than control group (28％ vs.20％, P =0.020).Recurrence of ventricular tachycardia or ventricular fibrillation after esmolol treatment was significantly lower, the corresponding were less (3.30± 2.76 vs.6.83 ± 4.58, P =0.001).Esmolol group was no occurrence of hypotension that could not be corrected or severe slow arrhythmia.NTproBNP level between the two groups was not statistically significant observation (P ＞ 0.05).Conclusion Esmolol treatment of sympathetic storm is better efficacy, safety and be worthy of clinical application.
ABSTRACT
Diencephalic seizure or sympathetic storm is a rare condition characterized by paroxysmal episodes of acute increase in heart rate, blood pressure, respiratory rate, temperature and diaphoresis with extensor posturing that can occur, following brain injury. Here we report a case of a 45-year-old male with hemorrhagic stroke who had symptoms of diencephalic seizure during his hospital stay.
ABSTRACT
Presentamos el caso de un hombre de 24 años que, secundario a un accidente de tránsito, presentó un traumatismo encefalocraneano grave con daño axonal difuso. Luego de un mes de evolución en la unidad de cuidados intensivos comenzó a presentar episodios súbitos de hipertensión, taquicardia, diaforesis, hipertermia, descerebración y dilatación pupilar, todo lo anterior con resolución espontánea en el curso de minutos. Estas crisis se repetían varias veces en el día. Se llegó al diagnóstico de un cuadro denominado Tormenta Simpática Paroxística que puede presentarse muy ocasionalmente como consecuencia de una lesión cerebral grave, especialmente el daño axonal postraumático. En este trastorno prima un desbalance simpático/parasimpático, lo que podría deberse a una pérdida del control cortical. El paciente fue tratado con opiáceos y betabloqueo con una respuesta satisfactoria, logrando disminuir significativamente sus episodios de tormentas simpáticas paroxísticas. En suma, nos parece importante comunicar esta experiencia dado la alta prevalencia de pacientes con trauma cerebral en nuestras Unidades de Pacientes Críticos. A pesar de que ni su diagnóstico ni tratamiento mejoran el pronóstico, su reconocimiento ahorra estudios innecesarios y permite iniciar una terapia sencilla que lleva al control precoz de la sintomatología.
A 24-year-old man suffered a traumatic brain injury due to a car accident. After one month of hospitalization in intensive care unit, he experimented episodic crisis of hypertension, tachycardia, hyperhidrosis, hypertermia, extensor posturing and pupil dilatation. This events presented in average 10 times per day. We reached to the diagnosis of Paroxysmal Sympathetic Storm. This is a subtype of dysautonomy which is present occasionally after a brain traumatic injury. The main mechanism of this brain dysfunction is a disassociation between the sympathetic and parasympathetic nervous systems due to cortical control loss. The patient was treated with morphine and labetalol and he experimented an excellent response, reducing his episodes of paroxysmal sympathetic storm by 80 percent. The aim of this review is to communicate this entity because a prompt and accurate diagnosis could minimize unnecessary studies and treatments.