2024 Volume 52 Issue 3 Pages 231-236
Takotsubo cardiomyopathy (TTC) is a cardiac dysfunction with uncertain pathophysiology. Approximately 1.2% of subarachnoid hemorrhage (SAH) cases are associated with TTC. Due to cardiac dysfunction, surgical and medical treatment of SAH in the acute phase is often difficult. Clazosentan (CLZ) is a newly approved drug for treating delayed cerebral vasospasm. Fluid retention is a serious secondary effect of CLZ, and it is uncertain whether CLZ is useful and safe in patients with complications that cause heart failure, such as TTC.
Here, we report a case of SAH associated with TTC treated with CLZ and discuss the safety and efficacy of CLZ for TTC following SAH.
The patient was a 79-year-old woman transported to our hospital with impaired consciousness. She was diagnosed with SAH due to rupture of a right middle cerebral artery bifurcation aneurysm. Transient cardiac dysfunction caused by TTC was also observed. After conservative treatment, her cardiac function improved, and neck clipping was performed on the third day. We began CLZ administration on the fifth day. No delayed cerebral vasospasm or cardiac failure was observed, and CLZ was discontinued on the 15th day. Furthermore, no deficits were observed. However, because of disuse syndrome, the patient was transferred to a different hospital for rehabilitation at an modified Rankin Scale score of 2.
Due to the surgery and CLZ administration after the improvement of cardiac function, as well as fluid balance management, CLZ use was deemed safe in this case.
