SHM Converge Scientific Abstract ePoster Gallery-A Partial Eclipse of the Heart

Pdf Summary

This case report describes a 14-year-old girl with hydrocephalus and a ventriculoatrial shunt who presented with lethargy and rapidly deteriorated after urinary catheterization, becoming apneic and requiring intubation. Head CT revealed obstructive hydrocephalus with tonsillar and brainstem herniation due to shunt malfunction. She underwent urgent shunt replacement and improved neurologically to baseline.<br /><br />During her PICU course, an echocardiogram obtained to locate the shunt catheter incidentally showed severe biventricular systolic dysfunction with an ejection fraction of 25%. By hospital day 3, cardiac function had improved substantially, with ejection fraction rising to 50–55%. EKG showed sinus tachycardia with flattened T waves. Her evaluation for other causes of heart failure, including myocarditis, endocarditis, myocardial infarction, coronary ischemia, and sepsis, was nonspecific. Infectious testing showed rhinovirus/enterovirus positivity and a urine culture positive for Pseudomonas, but these did not explain the acute cardiomyopathy.<br /><br />Given the tight temporal relationship between acute brain herniation and transient cardiac dysfunction, along with rapid recovery after neurologic decompression, she was diagnosed with neurogenic stunned myocardium (NCM). NCM is a diagnosis of exclusion characterized by acute, usually reversible myocardial dysfunction following severe neurologic injury. Formal diagnostic criteria are lacking, but typical findings include regional or global wall-motion abnormalities, elevated cardiac biomarkers, and nonspecific EKG changes.<br /><br />The report emphasizes that NCM is likely underrecognized and may result from sympathetic overactivation, myocardial microvascular dysfunction, or other mechanisms triggered by acute brain injury. Although NCM has been reported in children with hydrocephalus, this is presented as the first pediatric case linked specifically to shunt malfunction.

Asset Subtitle

Haley Ehrle

Meta Tag

Author List Haley Ehrle, Lee Morris

Category Clinical Vignettes

Concept Neurogenic Stunned Myocardium

Concept Diagnosis of Exclusion

Concept Shunt Malfunction

Concept Acute Heart Failure

Concept Diagnostic Criteria

Distinguished Non-Finalist

Presenter Organization Spectrum Health - - Grand Rapods, MI

Presenting Author Haley Ehrle

Track Pediatric

Keywords

hydrocephalus

ventriculoatrial shunt

shunt malfunction

brain herniation

obstructive hydrocephalus

neurogenic stunned myocardium

cardiomyopathy

biventricular dysfunction

pediatric case report

neurologic injury

Neurogenic Stunned Myocardium

Diagnosis of Exclusion

Shunt Malfunction

Acute Heart Failure

Diagnostic Criteria