Milrinone-associated Cardiomyopathy and Arrhythmia in Cerebral Vasospasm.

Milrinone-associated Cardiomyopathy and Arrhythmia in Cerebral Vasospasm.

World Neurosurg. 2018 Mar 30;:

Authors: Wu EM, El Ahmadieh TY, Kafka B, Davies MT, Aoun SG, White JA

Abstract
BACKGROUND: Milrinone is an inotropic and vasodilatory drug proven safe for use in the treatment of cerebral vasospasm. Despite its reported safety profile, its use is not free of side effects. Milrinone-associated cardiomyopathy and arrhythmia can occur in patients with cerebral vasospasm.
CASE DESCRIPTION: This is a retrospective chart review of a patient who presented with aneurysmal subarachnoid hemorrhage and developed clinical vasospasm twice over a period of two weeks. Sustained intravenous milrinone infusion was used in association with norepinephrine infusion during this period. The patient developed R on T triggered torsades de pointes and cardiogenic shock requiring resuscitation. A follow up echocardiogram showed decreased ejection fraction from 64% to 43% consistent with cardiac remodeling. Systemic complications such as cardiotoxicity and arrhythmias with the use of intravenous milrinone can be seen particularly when used in combination with catecholamines.
CONCLUSIONS: In an era of increased combined milrinone and catecholamine use for the treatment of cerebral vasospasm, physicians should be aware of the potential cardiac complications of these agents. Close monitoring with daily EKGs may be helpful to detect changes that may suggest cardiotoxicity. If changes are noted, an echocardiogram may be warranted as well as a cardiology consult.

PMID: 29609088 [PubMed - as supplied by publisher]

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