Abstract
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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References
Goldstein DS. The electrocardiogram in stroke: relationship to pathophysiological type and comparison with prior tracings. Stroke. 1979;10(3):253–9.
Weinberg SJ, Fuster JM. Electrocardiographic changes produced by localized hypothalamic stimulations. Ann Intern Med. 1960;53:332–41.
Zaroff JG, Rordorf GA, Newell BA, Ogilvy CS, Levinson JR. Cardiac outcome in patients with subarachnoid hemorrhage and electrocardiographic abnormalities. Neurosurgery. 1999;44:34–40.
Beard EF, Robertson JW, Robertson RCL. Spontaneous subarachnoid hemorrhage simulating acute myocardial infarction. Am Heart J. 1959;58:755–9.
Cropp GJ, Manning GW. Electrocardiographic changes simulating myocardial ischemia and infarction associated with spontaneous intracranial hemorrhage. Circulation. 1960;22:25–38.
Carruth JE, Silverman ME. Torsade de pointe atypical ventricular tachycardia complicating subarachnoid hemorrhage. Chest. 1980;78:886–8.
Cruickshank JM, Neil-Dwyer G, Brice J. Electrocardiographic changes and their prognostic significance in subarachnoid haemorrhage. J Neurol Neurosurg Psychiatry. 1974;37:755–9.
Sommargren CE. Electrocardiographic abnormalities in patients with subarachnoid hemorrhage. Am J Critical Care. 2002;11:48–56.
Brouwers PJ, Wijdicks EF, Hasan D, et al. Serial electrocardiographic recording in aneurysmal subarachnoid hemorrhage. Stroke. 1989;20:1162–7.
Di Pasquale G, Pinelli G, Andreoli A, Manini G, Grazi P, Tognetti F. Holter detection of cardiac arrhythmias in intracranial subarachnoid hemorrhage. Am J Cardiol. 1987;59:596–600.
Kreus KE, Kamila SJ, Takala JR. Electrocardiographic changes in cerebrovascular accidents. Acta Med Scand. 1969;185:327–34.
Solenski NJ, Haley Jr EC, Kassell NF, et al. Medical complications of aneurysmal subarachnoid hemorrhage: a report of the multicenter, cooperative aneurysm study. Crit Care Med. 1995;23:1007–17.
Kuroiwa T, Morita H, Tanabe H, Ohta T. Significance of ST segment elevation in electrocardiograms in patients with ruptured cerebral aneurysms. Acta Neurochir (Wien). 1995;133:141–6.
Shuster S. The electrocardiogram in subarachnoid hemorrhage. Br Heart J. 1960;22:316–20.
Arruda WO, de Lacerda Jr FS. Electrocardiographic findings in acute cerebrovascular hemorrhage: a prospective study of 70 patients. Arq Neuropsiquiatr. 1992;50:269–74.
Rudehill A, Olsson GL, Sundqvist K, Gordon E. ECG abnormalities in patients with subarachnoid haemorrhage and intracranial tumours. J Neurol Neurosurg Psychiatry. 1987;50:1375–81.
de Sweit J. Changes simulating hypothermia in the electrocardiogram in subarachnoid hemorrhage. J Electrocardiol. 1972;5:93–5.
Syverud G. Electrocardiographic changes and intracranial pathology. AANA J. 1991;59:229–32.
Eisalo A, Peräsalo J, Halonen PI. Electrocardiographic abnormalities and some laboratory findings in patients with subarachnoid haemorrhage. Br Heart J. 1972;34:217–26.
Cruickshank JM, Neil-Dwyer G, Stott AW. Possible role of catecholamines, corticosteroids, and potassium in production of electrocardiographic abnormalities associated with subarachnoid haemorrhage. Br Heart J. 1974;36:697–706.
Estañol BV, Badui ED, Cesarman E, et al. Cardiac arrhythmias associated with subarachnoid hemorrhage: prospective study. Neurosurgery. 1979;5:675–80.
Frontera JA, Parra A, Shimbo D, et al. Cardiac arrhythmias after subarachnoid hemorrhage: risk factors and impact on outcome. Cerebrovasc Dis. 2008;26:71–8.
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Chatterjee, S. ECG Changes in Subarachnoid Haemorrhage: A Synopsis. Neth Heart J 19, 31–34 (2011). https://doi.org/10.1007/s12471-010-0049-1
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DOI: https://doi.org/10.1007/s12471-010-0049-1