![]() ![]() It frequently mimics acute myocardial infarction, is often preceded by emotional or physiologic stress, and is thought to be mediated by excessive sympathetic discharge from the central nervous system (CNS). However, it is likely that few anesthesiologists were aware of this new syndrome (TLVAB) until publication of these two case reports. Cushing was one of the first to call attention to the effect of the brain on the heart over a century ago, and most anesthesiologists are acquainted with the not infrequent evidence of cardiac abnormalities (electrocardiogram changes, elevated enzymes, left ventricular dysfunction) associated with brain injury (especially with SAH and brain death). In this issue of Anesthesia & Analgesia our attention is redirected, to the potential adverse effects of the brain on the heart, by two case reports of the recently described syndrome of “Transient Left Ventricular Apical Ballooning (TLVAB)” (“Tako-Tsubo-like cardiomyopathy”) occurring after noncardiac surgery ( 1) and associated with subarachnoid hemorrhage (SAH) ( 2). Most anesthesiologists are well aware of the adverse effects of cardiac surgery, especially the use of cardiopulmonary bypass, on the brains of our patients. ![]()
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