Abnormal ECG patterns during the acute phase of subarachnoid hemorrhage in patients without previous heart disease

Abstract

<jats:title>Abstract</jats:title><jats:p>Subarachnoid hemorrhage (SAH) occurs primarily during early to mid-adulthood; approximately 30% of individuals with SAH die within 2 weeks, and mortality is 30% to 45%. SAH happens suddenly, without patients being aware of previous heart abnormalities. Here, we performed a pilot single cohort (historical) study to examine the hypothesis that early abnormal electrocardiographic (ECG) changes may reveal unknown but “silent” heart pathologies in SAH patients without previous heart disease (PHD). Data were collected retrospectively on 56 consecutive patients during the acute phase of SAH (29 men, 27 women; mean age 49.0 ± 6.2 years) with different degrees of neurologic deficit (Hunt-Hess scale assessment) in a 2-year period single-cohort study. Repolarization abnormalities were most frequent (p&lt;0.05) and were independent of a history of PHD, although it corresponded to a higher risk for such abnormalities (odds ratio OR=3.21; CI95%=1.01–10.22). ECG changes in patients without PHD were similar to those in PHD patients, confirming the hypothesis that SAH is associated with previously “silent” heart pathology. The increased frequency of ECG changes in PHD patients and their high incidence in no-PHD patients suggested a neurogenic form of myocardial dysfunction following SAH. Notably, repolarization changes were more frequent in patients with less severe deficit (p&lt;0.05), whereas rhythm and conductive abnormalities were more frequent in patients with more severe neurologic deficit.</jats:p>

Cerebral Venous Sinus Thrombosis - Diagnostic Strategies and Prognostic Models: A Review

“…The headache of CVST is typically described as diffuse and often progresses in severity over days to weeks. A minority of patients may present with thunderclap headache (Saposnik et al, 2011), suggestive of subarachnoid hemorrhage (SAH) (Atanassova et al, 2006), and a migrainous type of headache has been described. Isolated headache without focal neurological findings or papilledema occurs in up to 25% of the patients with CVST and presents a significant diagnostic challenge.…”

Previous Cardiac Abnormalities in Subarachnoid Hemorrhage May Also Have Background Genetic Polymorphisms

“…4 Being of increasing concern, we have recently emphasized the issue of abnormal ECG findings as eventual indices of pre-SAH cardiac pathology, in the view of neurological deficit. 5 Because SAH happens predominantly during the early adulthood and occurs suddenly and more than one-third of the patients may die within 2 weeks of admission, whether such patients may have had and/or have been considered to have any previous heart disease (PHD) is of extreme importance. We hypothesized that abnormal changes of ECG during the acute phase of SAH may be also an indication for unknown previous "silent" heart pathology.…”

“…The repolarization was more frequent in SAH patients with less severe neurological deficit (Hunt & Hess scale) whereas the rhythm and conductive abnormalities were more frequent in patients with more severe neurological deficit. 5 Moreover, in their multivariable models on the relationships of the specific adrenoceptor polymorphisms with post-SAH cardiac outcomes, 1 the authors had considered age, gender and race/ethnicity as possible covariates but neither history of hypertension nor history of coronary artery disease or neurological deficit were addressed as potential confounders and/or effect modifiers. Although presented with small prevalence (Table 2), no roles for risk factors of coronary artery disease such as diabetes or hyperlipidemia were mentioned, either.…”

Tako-Tsubo syndrome: A diagnostic challenge

“…We have read with interest the article of Atanassova et al [1] published in your respected Journal about electrocardiographic (ECG) changes during the acute phase of subarachnoid hemorrhage; which encouraged us to replay with regard to this subject.…”