A Narrative Review of Cardiovascular Abnormalities After Spontaneous Intracerebral Hemorrhage

Lele, Abhijit V.; Lakireddy, Viharika; Gorbachov, Sergii; Chaikittisilpa, Nophanan; Krishnamoorthy, Vijay; Vavilala, Monica S.

doi:10.1097/ana.0000000000000493

Cited by 15 publications

(18 citation statements)

References 138 publications

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“…Nevertheless, our cohort's mean values are within accepted normal laboratory limits and not reaching published thresholds for prognostication utility. A similar conclusion can be extended to hs-CRP [10] and cardiovascular POC biomarkers, D-dimer [13] and cTnI [16].…”

Section: Discussionsupporting

confidence: 52%

“…The prevalence of ischemic heart disease, stroke (including transient ischemic attacks) in the EsICH-bio cohort was greater than previous reports [3]. Diabetes mellitus, a factor of resistant hypertension [16], is known to be associated with in-hospital mortality of hemorrhagic stroke [48] and was recorded in almost one third of our cohort, alongside median baseline glycemic values similar to a previous report [49]. Admission hyperglycemia is an independent risk factor for early mortality [13,50], especially in nondiabetic patients [50].…”

Section: Discussionmentioning

confidence: 52%

“…Lack of compliance to BP lowering treatment was numerous among the cohort, despite being a known modifiable risk factor and predictor of mortality and outcome. Admission HR over 85 bpm has been reported as being associated with increased mortality and worse mRS [16].…”

Section: Discussionmentioning

confidence: 99%

“…D-dimer, a product of fibrin degradation, proved to be a risk factor for mortality [8,12,13] and early neurological deterioration (END) [14] and was associated with parenchymal hematoma volume [12,13]. Reports on cardiac troponin elevations (with subtypes I and T considered as largely offering identical information [15] are still controversially linked with mortality in spontaneous ICH (sICH) [9,16,17], yet have been shown as an indicator of poor outcome in subarachnoid hemorrhage [15].…”

Section: Background and Aimsmentioning

confidence: 99%

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Feasibility of a pilot study on point-of-care biomarkers in spontaneous intracerebral hemorrhage in an emergency setting

Mureșan

Golea

Bolboacă

et al. 2021

Medicine and Pharmacy Reports

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Background and aims. Stroke is a worldwide leading cause of death and disability and spontaneous intracerebral hemorrhage (sICH) has significant economic and social impact, regardless of recent efforts towards outcome-bettering acute interventions. The aim of the study was to assess the feasibility of a prospective observational research regarding point-of-care (POC) biomarkers in sICH, conducted in a level one emergency department (ED). Methods. Patients with acute (<8 hours) sICH were enrolled in this study. Patients presenting a Glasgow Coma Scale score <8, secondary causes of intracerebral hemorrhage, seizures, recent ischemic events, known thromboembolic disease, anticoagulant treatment, severe pre-stroke disability, terminal disease, scheduled neurosurgery/ hemostatic treatment were excluded. Feasibility was defined as ED inclusion and follow-up rates, time-to-inclusion, and frequency of missing data. Baseline demographic, imaging and POC biochemical status of the study group were documented, including inflammatory (complete blood count, C-reactive protein), metabolic (glucose, hepatic, and renal function) and cardiovascular markers (cardiac troponin I, D-dimer). Results. The inclusion rate was 2.16 patients/month with a final sample of 35 patients out of 239 potentially eligible patients. The median time from symptom onset to ED presentation was 128 minutes (IQR 96-239), with 21/35 patients having presented within the first 3 hours from ictus. Median times between symptoms’ onset to Computer Tomography (CT) scan and ED presentation to CT scan were 170 minutes (IQR 126-317) and 25 minutes (IQR 17-62), respectively. The median time from patient’s presentation to CBC result was 12 minutes (IQR 6.5-20), with 21/35 study participants having the results available within 15 minutes from ED arrival. The median cohort age was 72-years, with a 19/16 male/female ratio. Hypertension was the most frequent risk factor (77%), along with ischemic heart disease (31%) and diabetes (29%). One-third of the hypertensive patients did not undergo blood pressure lowering treatment. Median values of POC biomarkers on ED admission were within normal range. Conclusions. It was feasible to determine point-of-care biomarkers in spontaneous intracerebral hemorrhage on admission in ED, despite the urgency of the medical condition.

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Section: Discussionsupporting

confidence: 52%

Section: Discussionmentioning

confidence: 52%

Section: Discussionmentioning

confidence: 99%

Section: Background and Aimsmentioning

confidence: 99%

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Feasibility of a pilot study on point-of-care biomarkers in spontaneous intracerebral hemorrhage in an emergency setting

Mureșan

Golea

Bolboacă

et al. 2021

Medicine and Pharmacy Reports

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“…101,102 In patients with high-grade aneurysmal subarachnoid hemorrhage, myocardial dysfunction resulting from sympathetic hyperactivity should be suspected. 103 A variety of electrocardiographic abnormalities such as sinus bradycardia, sinus tachycardia, ST segment depression, T-wave inversion, U-waves, and prolonged QT interval occur commonly after aneurysmal subarachnoid hemorrhage. 104,105 Most often, the electrocardiographic abnormalities are neurogenic rather than cardiogenic.…”

Section: Preanesthesia Evaluationmentioning

confidence: 99%

Perioperative Management of Aneurysmal Subarachnoid Hemorrhage

Sharma

2020

Anesthesiology

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Aneurysmal subarachnoid hemorrhage is an acute neurologic emergency. Prompt definitive treatment of the aneurysm by craniotomy and clipping or endovascular intervention with coils and/or stents is needed to prevent rebleeding. Extracranial manifestations of aneurysmal subarachnoid hemorrhage include cardiac dysfunction, neurogenic pulmonary edema, fluid and electrolyte imbalances, and hyperglycemia. Data on the impact of anesthesia on long-term neurologic outcomes of aneurysmal subarachnoid hemorrhage do not exist. Perioperative management should therefore focus on optimizing systemic physiology, facilitating timely definitive treatment, and selecting an anesthetic technique based on patient characteristics, severity of aneurysmal subarachnoid hemorrhage, and the planned intervention and monitoring. Anesthesiologists should be familiar with evoked potential monitoring, electroencephalographic burst suppression, temporary clipping, management of external ventricular drains, adenosine-induced cardiac standstill, and rapid ventricular pacing to effectively care for these patients.

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Interaction of heart failure and stroke: A clinical consensus statement of the ESC Council on Stroke, the Heart Failure Association (HFA) and the ESC Working Group on Thrombosis

Doehner,

Böhm,

Boriani

et al. 2023

European J of Heart Fail

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Heart failure (HF) is a major disease in our society that often presents with multiple comorbidities with mutual interaction and aggravation. The comorbidity of HF and stroke is a high risk condition that requires particular attention to ensure early detection of complications, efficient diagnostic workup, close monitoring, and consequent treatment of the patient. The bi‐directional interaction between the heart and the brain is inherent in the pathophysiology of HF where HF may be causal for acute cerebral injury, and ‐ in turn ‐ acute cerebral injury via imbalanced neural and neurovegetative control of cardiovascular regulation may induce or aggravate HF.The present document represents the consensus view of the ESC Council on Stroke, the Heart Failure Association and the ESC Working Group on Thrombosis to summarize current insights on pathophysiologic interactions of the heart and the brain in the comorbidity of HF and stroke. Principal aspects of diagnostic workup, pathophysiologic mechanisms, complications clinical management in acute conditions and in long‐term care of patients with the comorbidity are presented and state of the art clinical management and current evidence from clinical trials is discussed. Beside the physicians perspective, also the patients values and preferences are taken into account.Interdisciplinary cooperation of cardiologists, stroke specialists, other specialists and primary care physicians is pivotal to ensure optimal treatment in acute events and in continued long‐term treatment of these patients. Key consensus statements are presented in a concise overview on mechanistic insights, diagnostic workup, prevention and treatment to inform clinical acute and continued care of patients with the comorbidity of heart failure and stroke.

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A Narrative Review of Cardiovascular Abnormalities After Spontaneous Intracerebral Hemorrhage

Cited by 15 publications

References 138 publications

Feasibility of a pilot study on point-of-care biomarkers in spontaneous intracerebral hemorrhage in an emergency setting

Feasibility of a pilot study on point-of-care biomarkers in spontaneous intracerebral hemorrhage in an emergency setting

Perioperative Management of Aneurysmal Subarachnoid Hemorrhage

Interaction of heart failure and stroke: A clinical consensus statement of the ESC Council on Stroke, the Heart Failure Association (HFA) and the ESC Working Group on Thrombosis

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