Electrocardiographic Changes in Cerebrovascular Accidents

Kreus, K.‐E.; Kemilä, S; Takala, Jorma

doi:10.1111/j.0954-6820.1969.tb07342.x

Cited by 69 publications

(8 citation statements)

References 20 publications

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“…The reported prevalence of ECG changes in patients with SAH ranges from 27% to 100% [3,[8][9][10][11][12]. Such wide variation may be due to differences in study design, investigators' definitions of ECG abnormalities, or the methods used to evaluate ECG changes.…”

Section: Prevalence Of Ecg Abnormalities In Sahmentioning

confidence: 99%

ECG Changes in Subarachnoid Haemorrhage: A Synopsis

Chatterjee

2010

Neth Heart J

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Subarachnoid haemorrhage (SAH) is a neurological emergency with high mortality rates. It is mainly caused by rupture of an aneurysm (congenital/infectious/ traumatic) or rupture of an arteriovenous malformation. Electrocardiograms (ECGs) done in patients with SAH have shown morphological changes as well as arrhythmias. Subarachnoid haemorrhage (SAH) patients have often been misdiagnosed to have cardiac abnormalities based on their ECGs when in many of those instances the ECG change had been the result of the SAH itself. They have led to unnecessary and wasteful investigations and therapies in many occasions. Hence the current article is an effort at consolidating the information available in an attempt to avoid possible errors in diagnosis by house staff and internists. There are two mechanisms that might mediate ECG changes in patients with SAH, i.e. autonomic neural stimulation from the hypothalamus or elevated levels of circulating catecholamine. Hypothalamic stimulation may cause ECG changes without associated myocardial damage whereas elevated catecholamine levels have been correlated with QT-interval prolongation and myocardial damage.

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Section: Prevalence Of Ecg Abnormalities In Sahmentioning

confidence: 99%

ECG Changes in Subarachnoid Haemorrhage: A Synopsis

Chatterjee

2010

Neth Heart J

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“…The prevalence of ECG changes in SAH patients is known to vary 2)5)12)17-19). Most of these ECG changes, such as sinus arrhythmias, are benign 4)6).…”

Section: Introductionmentioning

confidence: 99%

Clinically Significant Cardiac Arrhythmia in Patients with Aneurysmal Subarachnoid Hemorrhage

Jeong

Kim

2012

J Cerebrovasc Endovasc Neurosurg

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Objective Many previous studies have shown that electrocardiographic (ECG) changes occur patients with subarachnoid hemorrhage (SAH). This study was designed to identify the frequency, influencing factors, and outcome of clinically significant cardiac arrhythmias after SAH. Methods We retrospectively analyzed clinical data of 122 patients including ECG finding, age, sex, the Hunt-Hess grade, the Fisher's grade, the history of hypertension, peak blood pressure and heart rate, location of aneurysm, Glasgow Outcome Scale (GOS) score, the days of admission to the intensive care unit, the presence of symptomatic vasospasm. Results Of 122 SAH patients, 50% (n = 61) had a verified clinically significant arrhythmia. There were no statistically significant independent factors associated with clinically significant arrhythmia in multivariate analysis. Although adjustments for the effects of age, Hunt-Hess grade, and the presence of symptomatic vasospasm on death were made, clinically significant arrhythmias were still independently predictive of death (no arrhythmia versus arrhythmia, 11.5% versus 27.9%, adjusted odds ratio [OR] 3.524, 95% confidence interval [CI] 1.229-10.100, p = 0.019) and poor outcome (GOS ≤ 2, 13.1% versus 29.5%, adjusted OR 3.202, 95% CI 1.174-8.732, p = 0.023). Conclusion Clinically significant arrhythmias after SAH are associated with a high mortality rate, and serious cardiac and neurological comorbidity. Patients with an abnormal ECG on admission should undergo close cardiac monitoring, and the presence of rhythm disturbances should prompt aggressive measures to treat myocardial infarction (MI), maintain a normal cardiac rhythm, and minimize the presence of autonomic stress.

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“…Near- ly all of the commonly reported ECG changes, however, have been included the repolarization waveforms (ST segment, T and U waves), which reflects a subendocardial damage and reinforces the "catecholamine storm" theory [14,17,21] as the responsible mechanism for SAH-related cardiac involvements: rapidly excessive catecholamine release after SAH results in subendocardial contraction band necrosis. The overall influence of the ECG changes on patients' outcome has also been a matter of dispute, whereas the observations by many authors, in support of our findings, are in favor of ECG playing a role in the outcome [11,22]; others found no prognostic value for ECG abnormalities [14,17,[23][24][25]. The same viewpoint, mentioned earlier, can also explain different results on both the types of the ECG changes after SAH and their presumed effect on patients' outcome.…”

Section: Discussionmentioning

confidence: 90%

“…After the first description by Byer et al [12] in 1947, ECG changes in patients with SAH have been frequently investigated. The reported prevalence of ECG abnormalities varies from 27% to 100% among SAH patients [13][14][15], with rate of reversion to normal ranging from 40% to 100% in different studies [16,17]. Such factors as differences in the baseline ECG of the patients before SAH, methods of ECG evaluation, or the study designation (especially in terms of timing and frequency of ECG recordings) might have been involved in creating these varying results.…”

Section: Discussionmentioning

confidence: 99%

Electrocardiographic and Echocardiographic Changes in Subarachnoid Hemorrhage and Their Final Impact on Early Outcome: A Prospective Study Before and After the Treatment

et al. 2015

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Background:We aimed to prospectively investigate the changes in the electrocardiography (ECG) and the echocardiography of the patients with subarachnoid hemorrhage (SAH) before and after treatment, and to evaluate the overall role of the findings on early patients' outcome.Methods: All consecutive patients with SAH were evaluated with onadmission ECG and echocardiography. For those with an abnormal result, a second evaluation was performed after the therapeutic interventions. All of the participants were followed until discharged or possibly expired in the hospital. Proper statistical methods were used to compare the changes between the two groups of the patients: the "expired" group, and the "discharged" group.Results: Of the total of 60 subjects, 25 (41.6%) and three (5%) had an abnormal ECG and echocardiography that were dropped to four (6.7%) and one (1.7%) after treatment, respectively. The most frequent ECG finding was T-wave inversion. Six subjects (10%) were expired in the hospital. Abnormal primary ECG was found in five out of the six dead subjects (83.3%) and 20 out of the 54 discharged ones (37%) (P = 0.029). None of the three patients with abnormal primary echocardiograms were expired during the hospitalization. Conclusion:Most SAH-induced changes in the ECG and the echocardiography are transient and reversible. Abnormal ECG is a good predictor of inpatient mortality, but abnormal echocardiography is not.

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Electrocardiographic Changes in Cerebrovascular Accidents

Cited by 69 publications

References 20 publications

ECG Changes in Subarachnoid Haemorrhage: A Synopsis

ECG Changes in Subarachnoid Haemorrhage: A Synopsis

Clinically Significant Cardiac Arrhythmia in Patients with Aneurysmal Subarachnoid Hemorrhage

Electrocardiographic and Echocardiographic Changes in Subarachnoid Hemorrhage and Their Final Impact on Early Outcome: A Prospective Study Before and After the Treatment

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