Electrocardiographic Changes after Spontaneous Intracerebral Hemorrhage
Received: 03 May 2018
Accepted: 04 June 2018
22 April 2019 (eFirst)
Introduction Electrocardiographic (ECG) changes after ischemic stroke are well documented. However, ECG changes after spontaneous intracerebral hemorrhage (SICH) have been infrequently studied. In many cases, changes occur due to neurogenic causes and may be misinterpreted as primary cardiac events.
Aims This study was undertaken to study ECG changes after SICH.
Materials and Method This study included all SICH patients admitted over 1 year. Patients with intraventricular and subarachnoid hemorrhage without cerebral bleed were excluded, and those with a doubtful history of head injury were also excluded. Management was guided as per standard protocol. All patients were monitored in neurosurgical intensive care unit (ICU). ECG changes were noted and analyzed.
Results Total 47 SICH patients were admitted over 1 year; 0.66% patients were found to have one or more ECG abnormalities at time of admission. A prolonged QTc interval was the most common finding (39%), followed by sinus tachycardia or bradycardia and ST-segment changes. All patients with brainstem or intraventricular bleed had changes in ECG, whereas 62% had basal ganglia (BG) bleed, 43% thalamic bleed, and 57% had cortical bleeds had ECG changes, and 0.13% of patients had concomitant echocardiographic (ECHO) changes also. The most common change in BG lesion was T inversion as well as QTc prolongation in thalamic lesions. An equal percentage of males and females had ECG changes; however, 80% of all patients were males. All patients younger than 40 years had changes on ECG, and 75% of patients in the age group of 61 to 70 were found to have changes on ECG. In one patient with intraventricular hemorrhagic, global hypokinesia was reversed after insertion of ventricular drain and normalization of intracranial pressure (ICP). Although the management of the cardiac events may remain the same, in cases in which the primary cause is neurogenic, treating this cause or lowering ICP may help in reverting ECG changes.
Conclusion ECG changes occurring after SICH need to be cautiously interpreted, as the primary cause may be neurogenic and subsequent treatment would require lowering of ICP either surgically or medically.
- 1 Cropp GJ, Manning GW. Electrocardiographic changes simulating myocardial ischemia and infarction associated with spontaneous intracranial hemorrhage. Circulation 1960; 22: 25-38
- 2 Dimant J, Grob D. Electrocardiographic changes and myocardial damage in patients with acute cerebrovascular accidents. Stroke 1977; 8 (04) 448-455
- 3 Liu Q, Ding Y, Yan P, Zhang JH, Lei H. Electrocardiographic abnormalities in patients with intracerebral hemorrhage. Acta Neurochir Suppl (Wien) 2011; 111: 353-356
- 4 Popescu D, Laza C, Mergeani A, Bajenaru OA, Antochi FA. Lead electrocardiogram changes after supratentorial intracerebral hemorrhage. Maedica (Buchar) 2012; 7 (04) 290-294
- 5 Jaikar SKB, Divya NS, Rajan C. Analysis of electrocardiographic changes in cerebrovascular accidents. IOSR J Dental Med Sci 2014; 13 (05) 25-29
- 6 Daniele O, Caravaglios G, Fierro B, Natalè E. Stroke and cardiac arrhythmias. J Stroke Cerebrovasc Dis 2002; 11 (01) 28-33
- 7 Critchley HD, Mathias CJ, Josephs O. et al. Human cingulate cortex and autonomic control: converging neuroimaging and clinical evidence. Brain 2003; 126 (Pt 10) 2139-2152
- 8 Keller C, Williams A. Cardiac dysrhythmias associated with central nervous system dysfunction. J Neurosci Nurs 1993; 25 (06) 349-355
- 9 Gölbaşi Z, Selçoki Y, Eraslan T, Kaya D, Aydoğdu S. QT dispersion. Is it an independent risk factor for in-hospital mortality in patients with intracerebral hemorrhage?. Jpn Heart J 1999; 40 (04) 405-411
- 10 Pickham D, Helfenbein E, Shinn JA. et al. High prevalence of corrected QT interval prolongation in acutely ill patients is associated with mortality: results of the QT in Practice (QTIP) study. Crit Care Med 2012; 40 (02) 394-399
- 11 Soliman EZ, Howard G, Cushman M. et al. Prolongation of QTc and risk of stroke: the REGARDS (REasons for Geographic and Racial Differences in Stroke) study. J Am Coll Cardiol 2012; 59 (16) 1460-1467