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[Cardiac disease in intracerebral hematomas]
V Serrano-Castro1, A Gil-Peralta, J R González-Marcos
1Servicio de Neurologia, Hospital Universitario Virgen del Rocio, Sevilla, España.
Insights
Intracerebral hemorrhage can cause cardiac arrhythmias, with right-sided bleeds linked to supraventricular arrhythmias and left-sided bleeds potentially associated with sudden death. Continuous cardiac monitoring is recommended for patients with brain hematomas.
Area of Science:
- Neurology
- Cardiology
- Medical Research
Background:
- The central nervous system (CNS) significantly regulates cardiac function.
- CNS lesions, particularly intracerebral hemorrhages, are linked to ECG abnormalities like QT interval prolongation and arrhythmias, sometimes leading to sudden death.
- Autonomic nervous system imbalance, favoring sympathetic activity, is a proposed mechanism.
Purpose of the Study:
- To investigate cardiac changes in patients with non-severe intracerebral hemorrhage.
- To assess the impact of hematoma location (left vs. right hemisphere) and patient history (hypertension, heart disease) on ECG findings.
- To explore the relationship between intracerebral hemorrhage and cardiac arrhythmias.
Main Methods:
- A study involving 32 inpatients with non-severe intracerebral hemorrhage.
- Holter ECG monitoring was performed within 72 hours of hemorrhage and again after two months.
- ECG findings were analyzed concerning hematoma location and pre-existing cardiovascular conditions.
Main Results:
- 69.2% of patients exhibited ECG changes, and 73% had rhythm abnormalities.
- Supraventricular arrhythmias, specifically atrial extrasystoles, were significantly more common with right-hemisphere hematomas.
- No significant differences in ECG findings were observed based on a history of hypertension or heart disease.
- Two cases of sudden death occurred, both associated with left-hemisphere hematomas.
Conclusions:
- Right hemispheric hematomas are more frequently associated with supraventricular arrhythmias.
- Left hemispheric hematomas may be linked to severe ventricular arrhythmias and sudden death, warranting further investigation in larger cohorts.
- Continuous cardiac monitoring is advised for acute intracerebral hemorrhage cases.
Introduction And Objective:
The Central Nervous System (CNS) plays an essential role in the regulation of the cardiac function. There is strong evidence that many CNS lesions, mainly those of hemorrhagic origin, may induce repolarization abnormalities and enlargement of the QT interval (ECG changes) and several types of arrhythmias. In some cases these changes have been related to sudden death. The imbalance between the sympathetic and parasympathetic systems, favoring the former, seems to be the etiopathogenic factor.
Material And Methods:
We have carried out a study on thirty-two in-patients suffering from non-severe intracerebral hemorrhage, by means of a Holter ECG examination within the first 72 hours and a second record after two months. We have assessed any significative differences on the ECG findings in relation to the location of the hematoma (left or right hemispheres) and the presence of a personal history of arterial hypertension and/or heart disease.
Results:
One or more ECG changes were present in 69.2% of the patients and 73% showed one or more rhythm abnormalities. There was a higher incidence of supraventricular arrhythmias associated with the right hemisphere hematomas, with an statistical significance for the atrial extrasystolia. No differences were found between the group with a previous history of hypertension and/or heart disease and the one without these conditions. There were two cases of sudden death, both with left hemisphere hematomas, and in one of them the previous rhythm abnormalities were recorded.
Conclusions:
This study corroborates the hypothesis that right hemispheric hematomas induce supraventricular arrhythmias more frequently. The possible association between severe ventricular arrhythmias and sudden death with left-hemisferic hematomas should be studied in a higher number of patients. We recommend monitoring every acute case of intracerebral hematoma when possible.