Electrocardiographic findings in acute cerebrovascular hemorrhage a prospective study of 70 patients

Arruda, Walter Oleschko; Lacerda Jr., Flávio Suplicy de

doi:10.1590/S0004-282X1992000300002

Abstracts

Seventy patients with hemorrhagic stroke were prospectively evaluated regarding the electrocardiographic abnormalities observed within the first 48 hours of the ictus. Group I comprised 55 patients with spontaneous cerebral hemorrhage, and group II 15 patients with subarachnoid hemorrhage. Patients taking cardiac drugs (beta blockers, calcium-channel blockers, inotropic drugs) or with severe metabolic/electrolyte disturbances were excluded. The most common ECG abnormality was a prolonged Q-Tc interval: group I, 37 (67.2%); group II, 8 (53.3%). Only 4 (7.2% patients of group I and no patient of group II had a normal ECG. No relation was found between the site of the intracerebral hematoma and the occurrence of any particular ECG change. A prolonged Q-Tc may be related to the development of severe cardiac arrhythmias observed in some patients with acute cerebral hemorrhage.

cerebral hemorrhage; electrocardiogram; Q-Tc prolongation

Foram analisados os achados eletrocardiográficos obtidos dentro das primeiras 48 horas de instalação de acidente vascular cerebral hemorrágico em 70 pacientes. O grupo I foi composto de 55 pacientes com hematoma intracerebral espontâneo e o grupo II, de 15 pacientes com hemorragia subaracnóidea. Pacientes em uso de drogas cardíacas (beta bloqueadores, bloqueadores de cálcio, drogas inotrópicas) e/ou distúrbios metabólico/eletrolíticos graves foram excluídos. A alteração eletrocardiográfica mais comum em ambos os grupos foi o prolongamento do intervalo Q-Tc: grupo I, 37 (67,2%); grupo II, 8 (53,3%). Os eletroctardiogramas foram normais em 4 (7,2%) pacientes do grupo I e em nenhum paciente do grupo II. Não houve correlação significativa entre o local do hematoma cerebral e a ocorrência de alguma alteração específica do eletrocardiograma. O prolongamento do intervalo Q-Tc pode representar fator de risco potencial para o desenvolvimento súbito de arritmias cardíacas graves, observado em alguns pacientes com acidentes vasculares cerebrais hemorrágicos.

hemorragia cerebral; eletrocardiograma; prolongamento do intervalo

Walter Oleschko Arruda^I; Flávio Suplicy de Lacerda Jr.^II

^IDepartment of Neurology, Mayo Clinic (Rochester, USA)

^IIProfessor Adjunto, Especialidade de Cardiologia, Departamento de Clínica Médica, Universidade do Paraná (UFPR)

SUMMARY

Seventy patients with hemorrhagic stroke were prospectively evaluated regarding the electrocardiographic abnormalities observed within the first 48 hours of the ictus. Group I comprised 55 patients with spontaneous cerebral hemorrhage, and group II 15 patients with subarachnoid hemorrhage. Patients taking cardiac drugs (beta blockers, calcium-channel blockers, inotropic drugs) or with severe metabolic/electrolyte disturbances were excluded. The most common ECG abnormality was a prolonged Q-Tc interval: group I, 37 (67.2%); group II, 8 (53.3%). Only 4 (7.2% patients of group I and no patient of group II had a normal ECG. No relation was found between the site of the intracerebral hematoma and the occurrence of any particular ECG change. A prolonged Q-Tc may be related to the development of severe cardiac arrhythmias observed in some patients with acute cerebral hemorrhage.

Key words: cerebral hemorrhage, electrocardiogram, Q-Tc prolongation.

RESUMO

Foram analisados os achados eletrocardiográficos obtidos dentro das primeiras 48 horas de instalação de acidente vascular cerebral hemorrágico em 70 pacientes. O grupo I foi composto de 55 pacientes com hematoma intracerebral espontâneo e o grupo II, de 15 pacientes com hemorragia subaracnóidea. Pacientes em uso de drogas cardíacas (beta bloqueadores, bloqueadores de cálcio, drogas inotrópicas) e/ou distúrbios metabólico/eletrolíticos graves foram excluídos. A alteração eletrocardiográfica mais comum em ambos os grupos foi o prolongamento do intervalo Q-Tc: grupo I, 37 (67,2%); grupo II, 8 (53,3%). Os eletroctardiogramas foram normais em 4 (7,2%) pacientes do grupo I e em nenhum paciente do grupo II. Não houve correlação significativa entre o local do hematoma cerebral e a ocorrência de alguma alteração específica do eletrocardiograma. O prolongamento do intervalo Q-Tc pode representar fator de risco potencial para o desenvolvimento súbito de arritmias cardíacas graves, observado em alguns pacientes com acidentes vasculares cerebrais hemorrágicos.

Palavas-chave: hemorragia cerebral, eletrocardiograma, prolongamento do intervalo

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Dr. Walter Oleschko Arruda, M.D. Rua Gonçalves Dias 713 - 80240 Curitiba PR - Brasil.

1. Abildskow JA. Neural mechanisms involved in the regulation of ventricular repolarization. Eur J Heart 1985, 6 (supll D): 31-39.
2. Arruda WO, Ramina R. Edema agudo pulmonar neurogênico após ruptura de aneurisma intracraniano. Neurobiologia (Recife) 1989, 52:99-108.
2. Aschenbrenner R, Bodechtel G. über EKG. Veränderungen bei Hirntumorkranken. Klin Wschr 1938, 17:198-302.
3. Britton M, Faire U, Helmers C, Miah K, Ridking C, Wester PO. Arrhythmias in patients with acute cerebrovascular disease. Acta Med Scand 1979, 205:425-428.
4. Burch GE, Meyers R, Abildskov JA. A new electrocardiographic pattern observed in cerebrovascular accidents. Circulation 1954, 9:719-723.
5. Byer E, Ashman R, Toth LA. Electrocardiograms with large, upright T waves and long Q-T intervals. Am Heart J 1947, 33:796-806.
6. Cropp GJ, Manning GW. Electrocardiographic changes simulating myocardial ischemia and infraction associated with spontaneous intracranial hemorrhage. Circulation 1960, 22:25-38.
7. Goldman MJ. Principles of Clinical Electrocardiography. Ed. 12. Los Altos: Lange, 1986.
8. Goldstein DS. The electrocardiogram in stroke: relationship to pathophysiological type and comparison with prior tracings. Stroke 1979, 10:253-259.
9. Hachinski V, Norris JW. The Acute Stroke. Philadelphia: F.A. Davis, 1985.
10. Hammermeister KE, Reichenbach DD. QRS changes, pulmonary edema, and myocardial necrosis associated with subarachnoid hemorrhage. Am Heart J 1969, 78:94-100.
11. Hansson L, Larsson O. The incidence of ECG abnormalities in acute cerebrovascular accidents. Acta Med Scand 1974, 195:45-47.
12. Kolin A, Norris JW. Myocardial damage from acute cerebral lesions. Stroke 1984, 15:990-993.
13. Kreus KE, Kemila SJ, Takala JK. Electrocardiographic changes in cerebrovascular accidents. Acta Med Scand 1969, 185:327-334.
14. Marion DW, Segal R, Thompson ME, Subarachnoid hemorrhage and the heart. Neurosurgery 1986, 18:101-106.
15. Miura T, Tsuchihashi K, Yoshida E, Kobayashi K, Shimamoto K, Iimura O. Electrocardiographic abnormalities in cerebrovascular accidents. Jap J Med 1984, 23:22-26.
16. Myers M, Norris JW, Hachinski V. Plasma norepinephrine in stroke. Stroke 1981, 12:200-204.
17. Oppenheimer SM, Cechetto DF, Hachinski VC. Cerebrogenic cardiac arrhythmias: cerebral electrocardiographic influences and their role in sudden death. Arch Neurol 1990, 47:513-519.
18. Ramani A, Shetty U, Kundaje GN. Electrocardiographic abnormalities in cerebrovascular accidents. Angiology 1990, 41:681-686.
19. 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.
20. Sen S, Stober T, Burger L, Anstaett T, Rettig G. Recurrent Torsade de Pointes type ventricular tachycardia in intracranial hemorrhage. Intensive Care Med 1984, 10:263-264.
21. Stober T, Anstaett T, Sen S, Schimrgk ,K, Jaeger H. Cardiac arrhythmias in subarachnoid hemorrhage. Acta Neurochir (Wien) 1988, 93:37-44.
22. Stolar I, Hau I, Katz R, Racy A. P wave changes in intracerebral hemorrhage: clinical, electrocardiographic, and CT scan correlation. Am Heart J 1984, 107:784-785.
23. Talman WT. Cardiovascular regulation and lesions of the central nervous system. Ann Neurol 1985, 18:1-12.
24. Vidal BE, Dergal EB, Cesarman E, San Martin OM, Loyo M, Lugo BV, Ortega RP. Cardiac arrhytmias associated with subarachnoid hemorrhage: prospective study. Neurosurgery 1979, 5:675-680.
25. Yamour BJ, Sridharan MR, Rice JF, Flowers NC. Electrocardiographic changes in cerebrovascular hemorrhage. Am Heart J 1980, 99:294-300.

Electrocardiographic findings in acute cerebrovascular hemorrhage a prospective study of 70 patients

Achados eletrocardiogrráficos em hemorragia cérebro vascular aguda: estudo prospectivo de 70 casos

Publication Dates

Publication in this collection
22 Feb 2011
Date of issue
Sept 1992

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Abildskow JA. Neural mechanisms involved in the regulation of ventricular repolarization. Eur J Heart 1985, 6 (supll D): 31-39.

[2] 2. Arruda WO, Ramina R. Edema agudo pulmonar neurogênico após ruptura de aneurisma intracraniano. Neurobiologia (Recife) 1989, 52:99-108.

[3] 2. Aschenbrenner R, Bodechtel G. über EKG. Veränderungen bei Hirntumorkranken. Klin Wschr 1938, 17:198-302.

[4] 3. Britton M, Faire U, Helmers C, Miah K, Ridking C, Wester PO. Arrhythmias in patients with acute cerebrovascular disease. Acta Med Scand 1979, 205:425-428.

[5] 4. Burch GE, Meyers R, Abildskov JA. A new electrocardiographic pattern observed in cerebrovascular accidents. Circulation 1954, 9:719-723.

[6] 5. Byer E, Ashman R, Toth LA. Electrocardiograms with large, upright T waves and long Q-T intervals. Am Heart J 1947, 33:796-806.

[7] 6. Cropp GJ, Manning GW. Electrocardiographic changes simulating myocardial ischemia and infraction associated with spontaneous intracranial hemorrhage. Circulation 1960, 22:25-38.

[8] 7. Goldman MJ. Principles of Clinical Electrocardiography. Ed. 12. Los Altos: Lange, 1986.

[9] 8. Goldstein DS. The electrocardiogram in stroke: relationship to pathophysiological type and comparison with prior tracings. Stroke 1979, 10:253-259.

[10] 9. Hachinski V, Norris JW. The Acute Stroke. Philadelphia: F.A. Davis, 1985.

[11] 10. Hammermeister KE, Reichenbach DD. QRS changes, pulmonary edema, and myocardial necrosis associated with subarachnoid hemorrhage. Am Heart J 1969, 78:94-100.

[12] 11. Hansson L, Larsson O. The incidence of ECG abnormalities in acute cerebrovascular accidents. Acta Med Scand 1974, 195:45-47.

[13] 12. Kolin A, Norris JW. Myocardial damage from acute cerebral lesions. Stroke 1984, 15:990-993.

[14] 13. Kreus KE, Kemila SJ, Takala JK. Electrocardiographic changes in cerebrovascular accidents. Acta Med Scand 1969, 185:327-334.

[15] 14. Marion DW, Segal R, Thompson ME, Subarachnoid hemorrhage and the heart. Neurosurgery 1986, 18:101-106.

[16] 15. Miura T, Tsuchihashi K, Yoshida E, Kobayashi K, Shimamoto K, Iimura O. Electrocardiographic abnormalities in cerebrovascular accidents. Jap J Med 1984, 23:22-26.

[17] 16. Myers M, Norris JW, Hachinski V. Plasma norepinephrine in stroke. Stroke 1981, 12:200-204.

[18] 17. Oppenheimer SM, Cechetto DF, Hachinski VC. Cerebrogenic cardiac arrhythmias: cerebral electrocardiographic influences and their role in sudden death. Arch Neurol 1990, 47:513-519.

[19] 18. Ramani A, Shetty U, Kundaje GN. Electrocardiographic abnormalities in cerebrovascular accidents. Angiology 1990, 41:681-686.

[20] 19. 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.

[21] 20. Sen S, Stober T, Burger L, Anstaett T, Rettig G. Recurrent Torsade de Pointes type ventricular tachycardia in intracranial hemorrhage. Intensive Care Med 1984, 10:263-264.

[22] 21. Stober T, Anstaett T, Sen S, Schimrgk ,K, Jaeger H. Cardiac arrhythmias in subarachnoid hemorrhage. Acta Neurochir (Wien) 1988, 93:37-44.

[23] 22. Stolar I, Hau I, Katz R, Racy A. P wave changes in intracerebral hemorrhage: clinical, electrocardiographic, and CT scan correlation. Am Heart J 1984, 107:784-785.

[24] 23. Talman WT. Cardiovascular regulation and lesions of the central nervous system. Ann Neurol 1985, 18:1-12.

[25] 24. Vidal BE, Dergal EB, Cesarman E, San Martin OM, Loyo M, Lugo BV, Ortega RP. Cardiac arrhytmias associated with subarachnoid hemorrhage: prospective study. Neurosurgery 1979, 5:675-680.

[26] 25. Yamour BJ, Sridharan MR, Rice JF, Flowers NC. Electrocardiographic changes in cerebrovascular hemorrhage. Am Heart J 1980, 99:294-300.