Evaluation of electrocardiographic and echocardiographic changes in head injury patients before and after surgery

Background: Cardiac manifestations such as electrocardiographic (ECG) and echocardiographic changes are well known after acute brain injuries. These changes are most widely studied in aneurysmal subarachnoid haemorrhage but in traumatic brain injuries, there are few case reports or retrospective studies. None of the previous studies had assessed the effect of surgery on these changes. Hence, we planned to evaluate ECG and echocardiographic changes before and after surgery in the patients with isolated acute head injury undergoing surgery. Methodology: This prospective observational study was commenced after obtaining Institutional Ethics Committee approval. Totally, 60 patients with isolated head injury undergoing surgery were enrolled. Patients with history of premorbid cardiac disease and electrolyte abnormalities were excluded. First, ECG and echocardiography were obtained within 6 h of admission to the emergency room and second, evaluation was performed after 12 h post-operatively. Results: Of 60 patients, ECG abnormalities were observed in 37 (61.66%) patients pre-operatively and it decreased to 8 (13.33%) patients post-operatively (P = 0.0001). Pre-operative ECG changes include QTc prolongation (17, 28.33%), rhythm abnormalities (16, 26.66%), ST changes (12, 20%) and T-wave changes (7, 11.66%). It decreased to 4 (6.66%; P = 0.001), 0, 4 (6.66%; P = 0.008) and 1 (1.66%; P = 0.031), respectively after surgery. Only one patient developed regional wall motion abnormality (midventricular and apical hypokinesia) on echocardiography (1.67%) that improved immediately after surgery. Discussion: We conclude that the incidence of ECG changes is 61.66%, and echocardiographic changes are 1.67% in our study. Most of the changes both benign and malignant reversed significantly after decompression. Hence, we should focus on treating intracranial pathology even in the presence of cardiac changes. Only life-threatening arrhythmias need immediate attention. There are a few limitations in the study such as small and heterogeneous sample size.

No conflict of interest has been declared by the author(s).