ECG changes in pediatric patients with severe head injury
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Monali Dash1, Parmod K Bithal, Himanshu Prabhakar
1Department of Neuroanaesthesiology, All India Institute of Medical Sciences, New Delhi, India.
Insights
Electrocardiogram (ECG) changes, including severe ST depression, can occur in children with head injuries. These cardiac events may resolve with surgical treatment, highlighting the need for further pediatric research.
Area of Science:
- Pediatric Neurology
- Cardiology
- Trauma Care
Background:
- Electrocardiogram (ECG) changes associated with subarachnoid hemorrhage and head injury are well-documented in adults.
- Such cardiac manifestations are rarely reported in pediatric populations, leaving a gap in understanding.
Observation:
- Three pediatric patients (9 months, 2.5 years, and 12 years) with severe head injuries presented with significant ST segment depression on ECG during surgery.
- One infant experienced bradycardia and cardiac arrest following ST depression, requiring immediate resuscitation and surgical intervention.
Findings:
- Progressive ST segment depression, measuring 4 to 7 mm, was observed in all three pediatric head injury cases.
- Cardiac ischemic changes resolved to baseline in two patients following surgical treatment of their primary head injury.
- All patients recovered without neurological deficits after supportive ventilation.
Implications:
- This case series suggests that ECG changes and myocardial ischemia can occur in children following head injury, similar to adults.
- The findings underscore the importance of cardiac monitoring in pediatric head trauma patients.
- Further systematic studies are needed to elucidate the precise mechanisms of these ECG changes in children and inform clinical management.
Abstract:
Although ECG changes in subarachnoid hemorrhage and head injury have been described in adults, they have been rarely reported in children. We present 3 pediatric head-injured patients who developed severe ischemic changes on ECG. Three children (ages 9 months, 2.5 years, and 12 years) were admitted with severe head injury. All of them developed progressive ST segment depression of 4 to 7 mm during the surgical procedure. The first case, a 9-month-old child, also had bradycardia and cardiac arrest following ST depression. He was promptly resuscitated with simultaneous evacuation of extradural hematoma. In the other two cases, ST depression also gradually came up to baseline coinciding with surgical treatment of main pathology. All of the patients were ventilated postoperatively for 36 to 48 hours and discharged with no neurologic deficit. ECG changes and myocardial ischemia in head-injured patients have been attributed to extreme sympathetic stimulation and raised intracranial pressure in adults. But there has been no such systematic study in children. From our observations, we can conclude that ECG changes do occur in children with head injury, although the exact mechanism awaits further evaluation.
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