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Author Spotlight: Assessing Ischemic Stroke Damage Through Middle Cerebral Artery Occlusion Model
Published on: August 11, 2023
Transient Cardiac Dysfunction Following a Cerebrovascular Accident
Steven Hamilton1, Rana A Tauseen1, Sara L Wallach1
1Internal Medicine, Jersey Shore University Medical Center/Saint Francis Medical Center Program, Trenton, USA.
Insights
Cerebral T-waves, a rare ECG finding of deep T-wave inversion, can mimic cardiac events after acute brain injury. This case highlights the importance of considering neurological causes for seemingly cardiac symptoms.
Area of Science:
- Neurocardiology
- Neurology
- Cardiology
Background:
- Acute cerebral injuries frequently cause electrocardiogram (ECG) abnormalities, including arrhythmias and T-wave changes.
- Cerebral T-waves are a rare, specific ECG phenomenon characterized by transient, symmetric, deeply inverted T-waves in precordial leads, often associated with acute ischemic stroke.
Observation:
- A patient presented with symptoms suggestive of an ischemic cardiac event: acute pulmonary edema, precordial T-wave inversions, and left ventricular dysfunction.
- Initial cardiac workup raised suspicion for myocardial infarction, but subsequent brain imaging revealed an acute cerebral injury.
Findings:
- The patient's presentation mimicked a primary cardiac event, but the underlying cause was a neurological deficit.
- This case underscores the potential for cerebral T-waves to be misdiagnosed as primary cardiac ischemia.
Implications:
- Recognizing cerebral T-waves is crucial for accurate diagnosis and appropriate management of patients with acute neurological events.
- This phenomenon highlights the complex interplay between the brain and the heart, emphasizing the need for a comprehensive diagnostic approach.
Abstract:
Acute cerebral injuries are often accompanied by sudden electrocardiogram (ECG) changes such as cardiac arrhythmias, QT prolongation, and abnormal T-wave morphology. One rare phenomenon is "cerebral T-waves", which are T-waves observed in the context of stroke and described as transient, symmetric, and deeply inverted. The classic cerebral T wave is defined as a T-wave inversion of ≥5 mm depth in at least four contiguous precordial leads, and it is more commonly observed in the setting of acute ischemic stroke rather than hemorrhagic stroke. We describe the case of a patient who initially presented with acute pulmonary edema, T-wave inversions in the precordial leads, and left ventricular dysfunction on echocardiogram raising suspicion of an ischemic cardiac event. However, a brain CT scan performed on the third day of admission proved us wrong.
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