Olprinone, phosphodiesterase III inhibitor, is useful for patients with severe acute heart failure due to takotsubo cardiomyopathy accompanied by subarachnoid hemorrhage.

CASE: A 53-year-old woman with coma was diagnosed with subarachnoid hemorrhage and ruptured aneurysm at the right internal carotid-posterior communicating artery.

OUTCOME: The aneurysm was successfully clipped. Severe hypoxia and shock with abnormal left ventricular contraction were observed. We diagnosed severe acute heart failure with cardiogenic shock due to takotsubo cardiomyopathy complicated by subarachnoid hemorrhage. Neither catecholamine nor intra-aortic balloon pumping was selected to treat severe acute heart failure with cardiogenic shock because catecholamine generally worsens takotsubo cardiomyopathy and hematoma after surgery. Therefore, we gave olprinone and improved hypoxia and hemodynamics immediately without any arrhythmia.

CONCLUSION: Olprinone was effective for severe acute heart failure with cardiogenic shock due to takotsubo cardiomyopathy accompanied by subarachnoid hemorrhage. Catecholamine agents should be avoided if possible in patients with takotsubo cardiomyopathy. A phosphodiesterase III inhibitor may be useful for cardiogenic shock caused by takotsubo cardiomyopathy.