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Significance of ST segment elevation in electrocardiograms in patients with ruptured cerebral aneurysms
T Kuroiwa1, H Morita, H Tanabe
1Department of Neurosurgery, Osaka Mishima Critical Care Medical Center, Japan.
Insights
ST segment elevation in patients with subarachnoid hemorrhage (SAH) indicates transient cardiac dysfunction, not myocardial injury. Echocardiography confirmed temporary left ventricular apical wall motion abnormalities correlating with ECG changes.
Area of Science:
- Cardiology
- Neurology
- Critical Care Medicine
Background:
- Aneurysmal subarachnoid hemorrhage (SAH) can precipitate various cardiac complications.
- ST segment elevation on electrocardiograms (ECG) in SAH patients is not fully understood.
- Distinguishing cardiac dysfunction from myocardial injury is crucial for patient management.
Purpose of the Study:
- To investigate the cause of ST segment elevation in patients with aneurysmal subarachnoid hemorrhage (SAH).
- To determine if ST segment elevation reflects myocardial injury or transient cardiac dysfunction.
- To characterize the cardiac changes associated with SAH using echocardiography and cardiac catheterization.
Main Methods:
- Examined 23 patients with aneurysmal SAH and ST segment elevation on ECG.
- Utilized echocardiography and cardiac catheterization to assess cardiac function.
- Monitored ECG, echocardiograms, and serum myocardial enzymes during follow-up.
Main Results:
- ST segment elevation correlated with reduced left ventricular apical motion on echocardiography.
- Cardiac enzyme levels were normal or only slightly elevated in most patients.
- ECG and echocardiographic abnormalities resolved within one week in most cases.
Conclusions:
- ST segment elevation in acute SAH likely represents transient cardiac dysfunction.
- While some patients showed signs suggestive of myocardial injury, transient dysfunction is the primary finding.
- Close cardiac monitoring is recommended for SAH patients presenting with ECG changes.
Abstract:
Twenty-three patients with aneurysmal subarachnoid haemorrhage (SAH), who showed an ST segment elevation in their electrocardiograms (ECG), were examined. There were 12 males and 11 females, with a mean age of 61 years. The clinical condition on admission was Hunt and Kosnik grade II in four, III in seven, IV in one, and V in 11 patients. Computerized tomography (CT) also revealed many cases of diffuse, thick SAH or intracerebral or intraventricular haematoma. Laboratory examinations including serum electrolyte, pH, and PaO2 revealed no abnormalities that might have influenced the ECG. Elevation in the levels of myocardial enzymes in serum was observed in two of the nine patients examined, although the elevation was only slight in one of them. Echocardiography, which was performed on several occasions on all patients, and cardiac catheterization, which was performed on eight patients, revealed a reduction in the motion of the left ventricular apex that was synchronous with ST segment elevation. This is the first report about these phenomena. No abnormalities were observed in the coronary artery. The elevated ST segment was normalized within one week in all patients, accompanied by normalization of the apical wall motion recorded on echocardiograms. In four patients, however, T wave inversion accompanied the improvement of the ST segment and was normalized within three months after the onset. These results suggest that ST segment elevation in the acute stage of SAH reflects transient cardiac dysfunction rather than myocardial injury. In some patients, however, the elevated serum levels of myocardial enzymes or T wave inversion suggested the presence of myocardial injury. Close follow-up seems to be necessary in such cases.