Cardiovascular protection to improve clinical outcomes after subarachnoid hemorrhage: is there a proven role?

Cardiac abnormalities seen in patients with subarachnoid hemorrhage (SAH) are considered to be a neurally mediated process rather than a manifestation of coronary artery disease. In patients with SAH, myocardial injury evidenced by troponin elevation appears to predict short and long-term outcomes independently of other conventional risk. Although incidence of electrocardiographic changes, arrhythmias and left ventricular systolic dysfunction do not independently predict the outcomes, monitoring these changes and optimizing hemodynamic status in high-grade SAH is crucial to ensure adequate cerebral perfusion and arterial oxygenation. Novel interventions that go beyond blood pressure control, prevention of re-bleeding, and aneurysm obliteration should target early physiologic derangements seen in the acute phase of SAH. The early resuscitation phase in SAH represents the greatest opportunity for impacting clinical outcome and is thus the most promising window of opportunity to demonstrate a benefit when investigating novel therapeutic strategies related to protection and modulation of cardiovascular function. Specific measures, such as the early use of beta-adrenergic antagonists, to prevent these cardiac abnormalities and ameliorate its impact on morbidity and mortality are yet to be established.