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Left ventricular wall motion abnormalities in patients with subarachnoid hemorrhage: neurogenic stunned myocardium
Insights
Electrocardiogram (ECG) abnormalities in subarachnoid hemorrhage patients correlate with transient left ventricular wall motion issues. These neurogenic changes, mimicking heart attacks, are not due to coronary artery disease.
Area of Science:
- Cardiology
- Neurology
- Medical Imaging
Background:
- Electrocardiogram (ECG) changes mimicking myocardial infarction are common in subarachnoid hemorrhage (SAH).
- The relationship between these ECG abnormalities and left ventricular (LV) wall motion in SAH patients remains unclear.
- No prior studies have established a link between ECG findings and LV dysfunction in the context of SAH.
Purpose of the Study:
- To investigate the association between electrocardiographic (ECG) abnormalities and left ventricular (LV) wall motion.
- To determine if specific ECG patterns in subarachnoid hemorrhage (SAH) patients correlate with cardiac dysfunction.
- To differentiate neurogenic cardiac effects from coronary artery disease in SAH.
Main Methods:
- Studied 12 patients with subarachnoid hemorrhage (SAH), divided into groups based on ST-segment elevation on admission ECG.
- Assessed left ventricular (LV) regional wall motion using centerline method and two-dimensional echocardiography.
- Performed coronary angiography to exclude coronary artery disease as a cause of wall motion abnormalities.
Main Results:
- Patients with ST-segment elevation (Group I) showed significantly reduced left ventricular (LV) apical wall motion compared to those without (Group II).
- No evidence of coronary artery stenosis or vasospasm was found in any patient.
- Wall motion abnormalities resolved echocardiographically, though one patient died from SAH complications.
Conclusions:
- Subarachnoid hemorrhage (SAH) patients with ST-segment elevation may exhibit transient left ventricular (LV) wall motion abnormalities.
- These findings suggest a neurogenic origin for myocardial stunning in SAH.
- The precise mechanism of neurogenic stunned myocardium warrants further investigation.
Objectives:
The purpose of this study was to determine whether a relation exists between electrocardiographic (ECG) abnormalities and left ventricular wall motion in patients with subarachnoid hemorrhage.
Background:
Although ECG changes simulating acute myocardial infarction are frequently seen in patients with subarachnoid hemorrhage, their relation to left ventricular wall motion has not been established.
Methods:
Twelve patients with subarachnoid hemorrhage were classified according to the presence of ST segment elevation in at least two consecutive leads on admission: seven patients with ST segment elevation (group I) and five patients without ST segment elevation (group II). No patients had a previous history of heart disease. Left ventricular regional wall motion was evaluated by the centerline method. The mean (+/- SEM) duration from onset of subarachnoid hemorrhage to left ventriculography was 9 +/- 3 h in group I and 10 +/- 1 h in group II. Coronary angiography was performed to rule out wall motion abnormalities due to coronary artery disease while the ST segment was still elevated. Two-dimensional echocardiography was used to evaluate wall motion thereafter.
Results:
All patients in group I showed ST segment elevation in ECG leads V4 to V6. Wall motion of the left ventricular apex was significantly reduced in group I compared with group II (-2.48 +/- 0.41 vs. -0.45 +/- 0.72, p < 0.02). No patients showed organic stenosis or vasospasm, or both, of epicardial coronary arteries. Wall motion abnormalities decreased echocardiographically in all patients, but one patient in group I died in hospital at 2 or 3 weeks after the onset of subarachnoid hemorrhage, when the T wave was inverted in leads V4 to V6.
Conclusions:
These findings suggest that patients with subarachnoid hemorrhage and ST segment elevation may demonstrate transient corresponding regional wall motion abnormalities. The mechanism of neurogenic stunned myocardium was not clearly elucidated in the present study.