Predicting the Development of Myocardial Depression in Acute Neurological Patients

The purpose of this study is to investigate the level of plasma catecholamines, associated
with myocardial depression (MD) as noted on Transthoracic ECHO (TTE) by evidence of wall
motion abnormalities (WMA) with or without drop in ejection fraction or symptomatic heart
failure (HF). Takotsubo syndrome (TTS) is commonly diagnosed after the onset of HF once
patients become symptomatic. The investigators intend to study whether early MD can be
detected by identifying certain levels of plasma catecholamines and whether the level
correlates with severity of myocardial depression. Identification of early MD changes can
lead to alteration of management strategies and may help prevent worsening of HF. Highly
selected patients with Subarachnoid Hemorrhage (SAH) or Acute Ischemic Stroke (AIS) requiring
induced hypertension with the use of norepinephrine infusion will be recruited to enroll in
this pilot study. This group of patients are expected to have high circulating catecholamines
and are more likely to develop MD. Given the prevalence of TTS in females and elderly, 10
female patients >50 years admitted to the neuro ICU with diagnosis of either AIS or SAH will
be enrolled. Patients with history of coronary artery disease, smoking, poorly controlled
diabetes with HbA1c >8 and uncontrolled hypertension will be excluded. Patients with poor
ECHO windows will also be excluded. Baseline plasma catecholamine levels, transthoracic
ECHO(TTE), Troponin T, EKG and BNP will be obtained and will be followed daily through the
study duration.

Inclusion Criteria:

- female patients >50 years admitted to the neuro ICU with diagnosis of either acute
ischemic stroke or subarachnoid hemorrhage

- Only patients predicted to be on norepinephrine infusion for at least 48 hrs will be
selected.

Exclusion Criteria:

- patients with known history of heart failure will be excluded

- Patients with history of coronary artery disease, smoking, poorly controlled diabetes
with HbA1c >8 and uncontrolled hypertension will be excluded.

- Patients with poor ECHO windows will be excluded