Cardiovascular Manifestations of Acute Intracranial Lesions: Pathophysiology, Manifestations, and Treatment

Abstract

The objective of this article was to review the effects of acute intracranial lesions on myocardial function. The authors reviewed scientific and clinical literature retrieved from a computerized MEDLINE search from January 1965 through January 2002. Pertinent literature was referenced, including clinical and laboratory investigations, to demonstrate the effects of acute intracranial lesions on the cardiovascular system. The literature was reviewed to summarize the mechanisms of cardiac damage and clinical manifestations and treatment of cardiovascular dysfunction caused by acute intracranial lesions. Myocardial damage and rhythm disturbances were shown to occur with acute intracranial neurological disease. The subgroup of patients used in this study formed a substantial pool of cardiac donors for cardiac transplantation. The pathophysiology of myocardial dysfunction and the optimal management continues to be a source of debate. In this article, the authors will review the anatomy, the available evidence of the pathophysiology, and the management of this complex group of patients. They will also discuss areas that need to be further investigated. Cardiovascular effects of acute intracranial lesions are common and contribute to increased morbidity and mortality.

Cerebral Ischemia Elicits Aberration in Myocardium Contractile Function and Intracellular Calcium Handling

“…One of the important reasons causing a higher incidence and mortality of ischemic cerebrovascular disease is a cardiac dysfunction during the initial period of cerebral ischemia, which is revealed by changes in the ECG, elevation in cardiac enzyme, and live-threatening arrhythmias [2][3][4]. It has been well documented that prolonged QT intervals, depressed ST segments, inverted T waves, and ectopic ventricular beats were frequently observed in patients with ischemic cerebrovascular disease [5][6], suggesting that cardiac dysfunction may be the case that, at least in part, leads to death of those patients. Even though the imbalance between sympathetic and parasympathetic activity was found in those patients with cardiovascular disturbances induced by cerebrovascular diseases [7][8], the full understanding of underlying mechanisms of cerebral ischemia-induced cardiovascular disturbances has never been discovered.…”

Post-stroke Cardiac Complications

“…Cardiac dysfunction after a stroke is manifested by a wide variety of arrhythmias, ECG changes, elevated cardiac markers, and haemodynamic instability, which can lead to cardiogenic shock and subsequent death, as we have already alluded to earlier in the chapter [ 1 ]. Arrhythmias post-stroke are reported in up to 51 % of patients after ischaemic stroke and 78 % of patients after haemorrhagic stroke and are thus a common occurrence [ 41 ].…”

“…Central nervous system disorders are known to cause a wide array of cardiovascular system dysfunction, ranging from electrocardiogram (ECG) changes and transient myocardial dysfunction to sudden cardiac death [ 1 ]. Cardiac mortality is the second commonest cause of death behind direct neurological causes (see Fig.…”

QTc Aralığı Uzaması ve İnme: İskemik ve Hemorajik İnme Arasındaki Farklar

“…The presence of these ECG changes in the acute stroke setting may create a diagnostic and management dilemma, not only to cardiologist but also to neurologists. It is critical to distinguish that these ECG abnormalities are the cause behind developing stroke, are caused by stroke per se, or are totally unrelated to stroke 14,15 .…”