Published online May 9, 2022. doi: 10.5492/wjccm.v11.i3.149
Peer-review started: November 22, 2021
First decision: January 12, 2022
Revised: January 20, 2022
Accepted: March 16, 2022
Article in press: March 16, 2022
Published online: May 9, 2022
Processing time: 165 Days and 15.4 Hours
Critically ill patients are at risk of developing stress cardiomyopathy (SC) but can be under-recognized.
To describe a case series of patients with SC admitted to critical care units.
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.
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.
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.
Core Tip: In our retrospective study, we found that stress cardiomyopathy (SC) is often under-recognized in the critical care setting. Primary SC is commonly seen in the coronary care units and the secondary form predominates in the medical-surgical intensive care unit setting. Presentation of secondary SC is often atypical and the majority of patients have simultaneous acute respiratory failure and sepsis. High index of clinical suspicion for SC is needed in patients who develop sudden or worsening unexplained hemodynamic instability, arrhythmias or respiratory failure. Cardiac catheterization may not be always feasible to confirm the diagnosis. Routine utilization of point of care ultrasound on all intensive care unit patients will help identify more cases. The outcomes of these patients are excellent as majority of them show reversibility of cardiac function on follow up imaging.