A Study of Spectrum of Cardiac Rhythm Disturbance after Acute Ischemic Stroke Using 24 Hours Holter Monitoring
Anirban Saha1, Santosh Kumar Kairi1, Debaprasad Chakrabarti1
1Tripura Medical College and B .R. Ambedkar Memorial Teaching Hospital, Agartala.
Insights
Acute ischemic stroke frequently causes electrocardiogram (ECG) abnormalities and cardiac arrhythmias, even without prior heart disease. Early detection of these heart rhythm disturbances is crucial for effective stroke patient management.
Area of Science:
- Cardiology
- Neurology
- Autonomic Nervous System Research
Background:
- Acute stroke disrupts central autonomic control, potentially leading to myocardial injury, ECG abnormalities, and cardiac arrhythmias.
- Patients experiencing acute cerebrovascular events exhibit increased susceptibility to cardiac arrhythmias.
Purpose of the Study:
- To investigate the prevalence and types of cardiac arrhythmias and electrocardiogram (ECG) changes in patients with acute ischemic stroke.
- To assess the association between acute ischemic stroke and cardiac complications.
Main Methods:
- A cross-sectional study conducted over 1.5 years included patients with acute ischemic stroke confirmed by brain imaging.
- Standard 12-lead ECG and 24-hour Holter monitoring were performed on eligible stroke patients in the emergency ward.
Main Results:
- Abnormal ECG findings were observed in 35.28% of 92 stroke patients, including left ventricular hypertrophy (LVH), T-wave inversion, ST-segment depression, and QTc prolongation.
- 24-hour Holter monitoring revealed common rhythm disturbances: ventricular ectopics (44.57%), supraventricular ectopics (30.43%), supraventricular tachycardia (11.96%), and atrial fibrillation (7.60%). Sinus pause was noted in 1.09%.
Conclusions:
- Electrocardiogram (ECG) changes are common in acute ischemic stroke, irrespective of a prior history of coronary heart disease.
- Identifying paroxysmal atrial fibrillation is critical for guiding long-term treatment strategies in stroke patients.
Abstract:
Studies have reported that acute stroke leads to imbalance of central autonomic control; stroke can cause over activity of sympathetic or parasympathetic control, myocardial injury, ECG abnormalities, cardiac arrhythmias and even sudden death. Studies support the notion that patients with acute cerebrovascular events are susceptible to cardiac arrhythmias.
Material:
This cross Sectional Study was conducted in over a period of One and half year duration and included subjects of acute ischemic stroke confirmed by brain imaging. After performing a 12 lead ECG in emergency ward, all eligible stroke patients were subjected to 24 hour Holter monitoring.
Observation:
Out of 92 stroke patients, 35.28% had abnormal ECG. Changes included LVH in 10.87%, T wave inversion in 9.78%, ST segment depression in4.35%% followed by QTc prolongation 3.26% .24 hours Holter monitoring revealed that common cardiac rhythm disturbances were ventricular ectopics (44.57%) supraventricular ectopics (30.43%), supraventricular tachycardia (11.96%), atrial fibrillation (7.60%). Amongst brady-arrhythmias sinus pause was detected in 1.09%.
Conclusion:
ECG changes occur commonly in case of acute ischemic stroke, even in those having no history of coronary heart disease as suggested clinically. Identification of paroxysmal Atrial Fibrilation episodes is important due to its relevance for planning of long-term treatment.
Related Concept Videos
01:23Holter Monitor: 24-Hour Monitoring
01:30Pulse rhythm
Conversely, an irregular pulse pattern is termed dysrhythmia, stemming from disruptions in cardiac...
01:29Electrocardiogram
Three major waveforms are present in a typical ECG recording: the P wave, the QRS complex, and...
01:30Dysrhythmias V: Evaluating Dysrhythmias
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:29Dysrhythmias III: Characteristics of Dysrhythmias