Electrocardiographic changes following intracranial haemorrhage: a retrospective cohort study

Yaghmoor, Bassam E.; Alotaibi, Shayma M.; Enani, Maryam Z.; AlQudsi, Hussam S.; Aljehani, Masaheer A.; Althomali, Mshari H.; Hisan, Fatimah; Sindi, Ghaidaa; Alshoaibi, Naeem A.; Sabbagh, Abdulrahman J.

doi:10.17712/nsj.2020.2.20190109

Cited by 2 publications

(6 citation statements)

References 37 publications

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“…Contrary to what occurred in the present case, previous research reported that death in patients with IPH was more common in cases in which changes in the ST segment were not observed (2).…”

Section: Discussioncontrasting

confidence: 99%

“…As observed in the present case, nontraumatic IPH results from small artery bleeding, commonly due to hypertension (15,16), and it generally occurs in patients older than 60 years of age (16). Previously, Yaghmoor et al (2) reported an IPH prevalence of 23% among all ICHs.…”

Section: Discussionsupporting

confidence: 64%

“…In the present study, ST-segment elevation was evidenced in a patient with IPH who was initially treated as a myocardial infarction. The most common ECG alterations after IPH include repolarization abnormalities, such as QT interval prolongation and ST-segment and T-wave changes (15), of which QT interval prolongation is the most frequent (2,3).…”

Section: Discussionmentioning

confidence: 99%

“…It has been suggested that, to decrease or predict the occurrence of unfavorable results after ICH, cardiac monitoring should be performed in addition to the ECG to detect arrhythmias during the first 2 to 3 days after hospitalization (2).…”

Section: Discussionmentioning

confidence: 99%

“…Several electrocardiogram (ECG) abnormalities are frequently found in patients without heart disease who experience an ischemic stroke or subarachnoid hemorrhage (SAH). However, knowledge about the ECG changes in patients with intracranial hemorrhage (ICH) is currently limited, including subdural hemorrhage and intraparenchymal hemorrhage (IPH), which are the most frequent and second most frequent ICHs, respectively (1,2). Among the most common ICH ECG abnormalities are ST segment depression, left ventricular hypertrophy, prolongation of the corrected QT interval and inversion of the T wave (3).…”

Section: Introductionmentioning

confidence: 99%

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ST‑segment elevation associated with intraparenchymal hemorrhage: A case report

et al. 2023

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The electrocardiogram (ECG) changes in patients with intraparenchymal hemorrhage (IPH) have remained largely elusive and no case reports are currently available in the scientific literature. The medical management of a patient with ST-segment elevation associated with IPH was described in the present study. The case report describes a 78-year-old male patient who presented with ST-segment elevation in V1, V2, V3 and V4 on ECG. Initially, the case was managed therapeutically as an acute myocardial infarction. Later, the patient was transferred to a higher-level hospital, where a new ECG confirmed ST-segment elevation. Simple skull tomography was also performed, which revealed a spontaneous right basal ganglion in the context of an acute cerebrovascular accident of hypertensive origin. A transthoracic ECG was ordered, which revealed an ejection fraction of 65% with type I diastolic dysfunction due to relaxation disorders and without any signs of ischemia, intracavitary masses or thrombi. In addition to the presence of nonspecific ECG findings, clinicians should consider immediate brain computed tomography to confirm intracranial hemorrhage.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionsupporting

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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ST‑segment elevation associated with intraparenchymal hemorrhage: A case report

et al. 2023

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Early Cardiac Evaluation, Abnormal Test Results, and Associations with Outcomes in Patients with Acute Brain Injury Admitted to a Neurocritical Care Unit

Lele,

Liu,

Kunapaisal

et al. 2024

JCM

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Background: to examine factors associated with cardiac evaluation and associations between cardiac test abnormalities and clinical outcomes in patients with acute brain injury (ABI) due to acute ischemic stroke (AIS), spontaneous subarachnoid hemorrhage (SAH), spontaneous intracerebral hemorrhage (sICH), and traumatic brain injury (TBI) requiring neurocritical care. Methods: In a cohort of patients ≥18 years, we examined the utilization of electrocardiography (ECG), beta-natriuretic peptide (BNP), cardiac troponin (cTnI), and transthoracic echocardiography (TTE). We investigated the association between cTnI, BNP, sex-adjusted prolonged QTc interval, low ejection fraction (EF < 40%), all-cause mortality, death by neurologic criteria (DNC), transition to comfort measures only (CMO), and hospital discharge to home using univariable and multivariable analysis (adjusted for age, sex, race/ethnicity, insurance carrier, pre-admission cardiac disorder, ABI type, admission Glasgow Coma Scale Score, mechanical ventilation, and intracranial pressure [ICP] monitoring). Results: The final sample comprised 11,822 patients: AIS (46.7%), sICH (18.5%), SAH (14.8%), and TBI (20.0%). A total of 63% (n = 7472) received cardiac workup, which increased over nine years (p < 0.001). A cardiac investigation was associated with increased age, male sex (aOR 1.16 [1.07, 1.27]), non-white ethnicity (aOR), non-commercial insurance (aOR 1.21 [1.09, 1.33]), pre-admission cardiac disorder (aOR 1.21 [1.09, 1.34]), mechanical ventilation (aOR1.78 [1.57, 2.02]) and ICP monitoring (aOR1.68 [1.49, 1.89]). Compared to AIS, sICH (aOR 0.25 [0.22, 0.29]), SAH (aOR 0.36 [0.30, 0.43]), and TBI (aOR 0.19 [0.17, 0.24]) patients were less likely to receive cardiac investigation. Patients with troponin 25th–50th quartile (aOR 1.65 [1.10–2.47]), troponin 50th–75th quartile (aOR 1.79 [1.22–2.63]), troponin >75th quartile (aOR 2.18 [1.49–3.17]), BNP 50th-75th quartile (aOR 2.86 [1.28–6.40]), BNP >75th quartile (aOR 4.54 [2.09–9.85]), prolonged QTc (aOR 3.41 [2.28; 5.30]), and EF < 40% (aOR 2.47 [1.07; 5.14]) were more likely to be DNC. Patients with troponin 50th–75th quartile (aOR 1.77 [1.14–2.73]), troponin >75th quartile (aOR 1.81 [1.18–2.78]), and prolonged QTc (aOR 1.71 [1.39; 2.12]) were more likely to be associated with a transition to CMO. Patients with prolonged QTc (aOR 0.66 [0.58; 0.76]) were less likely to be discharged home. Conclusions: This large, single-center study demonstrates low rates of cardiac evaluations in TBI, SAH, and sICH compared to AIS. However, there are strong associations between electrocardiography, biomarkers of cardiac injury and heart failure, and echocardiography findings on clinical outcomes in patients with ABI. Findings need validation in a multicenter cohort.

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Electrocardiographic changes following intracranial haemorrhage: a retrospective cohort study

Cited by 2 publications

References 37 publications

ST‑segment elevation associated with intraparenchymal hemorrhage: A case report

ST‑segment elevation associated with intraparenchymal hemorrhage: A case report

Early Cardiac Evaluation, Abnormal Test Results, and Associations with Outcomes in Patients with Acute Brain Injury Admitted to a Neurocritical Care Unit

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