Electrocardiographic changes and myocardial damage in patients with acute cerebrovascular accidents.

Abstract

In 100 consecutive patients with acute cerebrovascular accident, due to cerebral thrombosis in 72, cerebral hemorrhage in 12, embolus in 6, and subarachnoid hemorrhage in 10, there were 90 who had electrocardiographic abnormalities during the first three days after admission, compared to 50% in a control group. The patients with cerebrovascular accident had a 7- to 10-fold higher incidence of ST segment depression, prolonged Q-Tc interval and atrial fibrillation, and a 2- to 4-fold higher incidence of T wave inversion, conduction defects, premature ventricular beats and left ventricular hypetrophy. Patients who died had a 2-, 3- and 5-fold higher incidence of electrocardiographic evidence of recent myocardial infarction, atrial fibrillation and conduction defects than those who survived, but these changes occurred in only 5, 21 and 14% of all patients, and other electrocardiographic changes could not be correlated with mortality. During the first three days after admission 29 patients had elevation of serum enzymes which may be derived from cardiac muscle, particularly CPK, which was increased 6-fold, compared to 2-fold increases in HBDH, GOT, and LDH. Only 5 of these patients had electrocardiographic evidence of recent myocardial infarction. Patients with elevated serum CPK had a 2-fold higher incidence of ST segment depression, T wave inversion, conduction defects and atrial fibrillation than those with normal CPK, and a mortality of 66%, compared to 30%. Of 41 patients who died, 49% had elevated serum CPK, compared to 15% of 59 patients who survived. These differences were significant (P less than 0.01). Serum CPK was more frequently helpful than the electrocardiogram in evaluating the extent of cardiac damage and in predicting mortality. Patients with acute cerebrovascular accident should have repeated evaluation of serum CPK and the ECG, and be monitored for arrhythmias.

Guidelines for the Early Management of Adults With Ischemic Stroke

“…For example, acute myocardial infarction can lead to stroke, and acute stroke can lead to myocardial ischemia. [77][78][79] In addition, cardiac arrhythmias can occur among patients with acute ischemic stroke. 77,78,80,81 Atrial fibrillation, an important potential cause of stroke, can be detected in the acute setting.…”

Guidelines for the Early Management of Patients With Acute Ischemic Stroke

“…Ischemic stroke can also cause electrocardiogram abnormalities and, occasionally, cardiac decompensation (cardiomyopathy) via neurohormonal pathways. [136][137][138][139] Because of the close association between stroke and cardiac abnormalities, it is important to assess the cardiovascular status of patients presenting with acute stroke. Baseline electrocardiogram and cardiac biomarkers may identify concurrent myocardial ischemia or cardiac arrhythmias.…”

The Brain–Heart Connection

“…In a series of 100 consecutive stroke patients, 90% showed abnormalities on the ECG compared with 50% of a control population of 100 patients admitted for carcinoma of the colon. 29 This of course does not mean that 90% of stroke patients have neurogenic ECG changes. Obviously, stroke and coronary artery disease have common risk factors, so that many ECG abnormalities in stroke patients represent concomitant atherosclerotic coronary disease.…”