[Subarachnoid hemorrhage: electrocardiographic, left ventricular wall motion abnormalities and mortality analysis in
J C Muñoz1, J A San Román, L de la Fuente
1Servicios de Cardiología, Hospital Universitario, Valladolid, Madrid.
Insights
Electrocardiogram (ECG) changes in subarachnoid hemorrhage (SAH) patients are linked to left ventricular (LV) dysfunction. Abnormal ECGs and echocardiograms indicate more severe brain injury and higher mortality in SAH patients without prior heart disease.
Area of Science:
- Cardiology
- Neurology
- Medical Imaging
Background:
- Electrocardiographic (ECG) changes are common in subarachnoid hemorrhage (SAH).
- The relationship between ECG abnormalities and left ventricular (LV) wall motion abnormalities in SAH patients remains unclear.
- This study investigates ECG and echocardiographic findings in SAH patients without pre-existing heart conditions.
Observation:
- Fourteen SAH patients without prior heart disease were assessed for neurological damage (Hunt-Hess scale), ECG, and echocardiographic parameters.
- Abnormal ECGs were observed in 11 patients (79%), with ST segment or T wave changes.
- Echocardiographic alterations were present in 5 patients (36%), all exhibiting concurrent ECG changes.
Findings:
- Patients with echocardiographic abnormalities had significantly higher neurological damage (mean Hunt-Hess grade 4.6 vs. 2.7, p < 0.001).
- Mortality was substantially higher in patients with abnormal ECGs (91% vs. 0%, p = 0.01).
- Dobutamine infusion improved LV ejection fraction in one patient with severely depressed function.
Implications:
- Echocardiographic abnormalities in SAH patients are associated with ECG changes, particularly ST segment alterations.
- These cardiac findings correlate with more severe cerebral damage and increased mortality risk in SAH.
- Early cardiac assessment may be crucial for risk stratification and management of SAH patients.
Background:
Electrocardiographic (ECG) changes have been frequently observed in patients with subarachnoid hemorrhage (SAH). Their association with wall motion abnormalities of the left ventricle (LV) have not been well established.
Patients And Methods:
Sixteen patients with SAH were included; 2 patients with previous history of heart disease were subsequently excluded. We studied the neurological damage (Hunt-Hess grading scale), ECG (ST segment, T wave) and echocardiography (LV regional and global contractility) of 14 patients.
Results:
The ECG was abnormal in 11 patients (T wave: 6 patients; ST segment: 5 patients). Echocardiography showed alterations in 5 patients, all of them with ECG changes (T wave: one patient; ST segment: 4 patients). The neurological lesion was higher in patients with abnormal echocardiogram (Hunt-Hess mean grade: 4.6 vs 2.7 in patients with normal echocardiogram; p < 0.001). An intravenous infusion of dobutamine in a 23 years old male, improved the LV ejection fraction, which was severely depressed at baseline. Mortality, in all cases secondary to the neurological damage, was higher in patients with abnormal ECG (91% vs 0% in patients with normal ECG; p = 0.01) and when the echocardiogram showed alterations although in the last case no statistical differences were found.
Conclusions:
Echocardiography abnormalities in patients with SAH and without previous history of heart disease are more frequently related to ECG changes affecting ST segment, and to a higher cerebral damage.
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