J-wave formation in patients with acute intracranial hypertension

Milewska, Agata; Guzik, Przemysław; Rudzka, Magdalena; Baranowski, Rafał; Jankowski, Ron; Nowak, S.; Wysocki, Henryk

doi:10.1016/j.jelectrocard.2009.04.001

Cited by 13 publications

(9 citation statements)

References 7 publications

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“…In this clinical setting we may also occasionally observe a specific repolarization abnormality designated as J wave [30], which was first described by Osborn in hypothermic subjects and was further reported in hypercalcemia, Brugada syndrome, vasospastic angina and, most importantly, intracranial hypertension [31]. It is defined as 1 mm positive notch at the end of QRS complex with duration of ≥ 10 ms. Cellular basis for J-wave consists in potential difference between the prominent transient outward potassium current (I to ) of epicardium and notably smaller I to current in the endocardial layer during phase 1 and 2 of ventricle repolarization [32].…”

Section: Subarachnoid Hemorrhage and Cardiac Dysfunctionmentioning

confidence: 82%

Neurocardiogenic injury in subarachnoid hemorrhage: A wide spectrum of catecholamin-mediated brain-heart interactions

2014

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Section: Subarachnoid Hemorrhage and Cardiac Dysfunctionmentioning

confidence: 82%

Neurocardiogenic injury in subarachnoid hemorrhage: A wide spectrum of catecholamin-mediated brain-heart interactions

2014

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“…Non hypothermic J wave is an infrequent electrocardiographic manifestation of subarachnoid hemorrhage and of acute brain injury [18,19].…”

Section: Discussionmentioning

confidence: 99%

A Huge J Wave in Mild-Hypothermic Patient with Acute Brain Injury

Luzi¹,

Giada²,

Massimo³

et al. 2015

J Neurol Neurosci

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The Osborn wave is a deflection immediately following the QRS complex of the surface ECG. It can be observed in hypothermic patients. A 51-year-old man was admitted to the emergency department of our hospital because of loss of consciousness with tonic-clonic seizures. The cranial computerized tomography (CT) showed intraparenchymal hematoma. After neurosurgical intervention, during hospitalization, the electrocardiogram (ECG) showed the presence of a huge Osborn wave.

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“…The common ECG changes that are documented with raised intracranial pressure are T inversions, prolongation of QT interval and sinus bradycardia. Yet ST elevation or depression, arrhythmias, neurogenic T waves, J waves and prominent U waves have all been recognized [1–4]. …”

Section: Introductionmentioning

confidence: 99%

Electrocardiographic changes mimicking acute coronary syndrome in a large intracranial tumour: A diagnostic dilemma

Yogendranathan

Herath

Pahalagamage

et al. 2017

BMC Cardiovasc Disord

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BackgroundST elevation Myocardial infarction is a medical emergency. A variety of noncardiac conditions had been known to mimic the ECG changes that are seen in acute coronary syndrome. Although the common ECG changes that are documented with raised intracranial pressure are T inversions, prolongation of QT interval and sinus bradycardia, ST elevation or depression, arrhythmias and prominent U waves have also been recognized. However, ST elevations in association with primary intracranial tumours are rarely reported.Case presentationA 68-year-old female patient with a large left sided frontoparietal sphenoidal ridge meningioma with mass effect developed sudden onset shortness of breath while awaiting surgery. Her ECG showed ST segment elevations in the inferior leads along with reciprocal T inversions in anterior leads. The patient was treated with dual antiplatelet therapy and unfractionated heparin. The ST elevations in the ECG remained static and the cardiac Troponin assay was repeatedly negative. 2D ECHO, coronary angiogram and CT pulmonary angiography were normal. The repeat noncontract CT scan of the brain revealed two small areas of haemorrhage in the tumour.ConclusionThe two mechanisms for ECG changes described in subarachnoid haemorrhage are the neurogenic stunned myocardium due to the catecholamine surge on the myocytes and stress cardiomyopathy. The same mechanisms could be the reasons for the ECG changes seen in intracranial tumours. These ECG changes could be easily misdiagnosed as acute coronary syndrome. This case emphasizes the importance of the cardiac biomarkers, 2D ECHO and coronary angiogram when confronted with such a diagnostic dilemma. Thus a more holistic analysis should be practiced in diagnosing acute coronary events in patients with intracranial pathologies to obviate a myriad of unnecessary investigations, interventions, costly treatment strategies which may well be detrimental to the patient.

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J-wave formation in patients with acute intracranial hypertension

Cited by 13 publications

References 7 publications

Neurocardiogenic injury in subarachnoid hemorrhage: A wide spectrum of catecholamin-mediated brain-heart interactions

Neurocardiogenic injury in subarachnoid hemorrhage: A wide spectrum of catecholamin-mediated brain-heart interactions

A Huge J Wave in Mild-Hypothermic Patient with Acute Brain Injury

Electrocardiographic changes mimicking acute coronary syndrome in a large intracranial tumour: A diagnostic dilemma

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