Stress cardiomyopathy in critical care:A case series of 109 patients

摘要

BACKGROUND Critically ill patients are at risk of developing stress cardiomyopathy(SC)but can be under-recognized.AIM To describe a case series of patients with SC admitted to critical care units.METHODS We conducted a retrospective observational study at a tertiary care teaching hospital.All adult(≥18 years old)patients admitted to the critical care units with stress cardiomyopathy over 5 years were included.RESULTS Of 24279 admissions to the critical care units[19139 to medical-surgical intensive care units(MSICUs)and 5140 in coronary care units(CCUs)],109 patients with SC were identified.Sixty(55%)were admitted to the coronary care units(CCUs)and forty-nine(45%)to the medical-surgical units(MSICUs).The overall incidence of SC was 0.44%,incidence in CCU and MSICU was 1.16%and 0.25%respectively.Sixty-two(57%)had confirmed SC and underwent cardiac catheterization whereas 47(43%)had clinical SC,and did not undergo cardiac catheterization.Forty-three(72%)patients in the CCUs were diagnosed with primary SC,whereas all(100%)patients in MSICUs developed secondary SC.Acute respiratory failure that required invasive mechanical ventilation and shock developed in twenty-nine(59%)MSICU patients.There were no statistically significant differences in intensive care unit(ICU)mortality,in-hospital mortality,use of inotropic or mechanical circulatory support based on type of unit or anatomical variant.CONCLUSION Stress cardiomyopathy can be under-recognized in the critical care setting.Intensivists should have a high index of suspicion for SC in patients who develop sudden or worsening unexplained hemodynamic instability,arrhythmias or respiratory failure in ICU.