Cardiac Arrhythmias and Sudden Death in Subarachnoid Hemorrhage

Abstract

Cardiac Arrhythmias and Sudden Death in Subarachnoid Hemorrhage• Life-threatening cardiac arrhythmias can occur in patients with subarachnoid hemorrhage secondary to rupture of intracranial aneurysms. The arrhythmias are secondary to acute dysfunction of the central nervous system and possibly to sudden increase in intracranial pressure. The autonomic nervous system is the mediator in the production of these disorders. The clinical significance of these rhythm disorders is discussed, particularly in regard to the sudden, unexpected death seen in this type of patient. The possible mechanisms of production are analyzed and their therapeutic implications are stressed.

Subarachnoid hemorrhage: frequency and severity of cardiac arrhythmias. A survey of 70 cases studied in the acute phase.

“…1718 The experiences of Parizel 17 and Estanol and Marin" seem to favor the latter assump- tion. The spontaneous 18 or pharmacologically induced 17 reversion to a normal sinus rhythm in the cases described by these authors and the subsequent improvement of the neurologic condition are demonstrative. Our experience, of torsade de pointe associated with ventricular fibrillation in a patient in good neurologic condition who showed cardiorespiratory arrest during Holter monitoring but who survived with cardiopulmonary resuscitation, indicates that prompt recognition and treatment of the cardiac disorders play an important role in the patients' survival.…”

“…It has been remarked that the death rate for SAH patients before arriving at a hospital appears to be about 15% 18 ' 3132 and 2) the aggressive diagnostic and therapeutic maneuvers carried out in the acute phase of SAH, particularly when an early surgery protocol is planned (early angiographic study and intracranial surgery, intraoperative hypotension, high-dose mannitol, induced hypervolemia, etc.) may not allow an adequate evaluation of the cardiac condition and, at the same time, may themselves be detrimental.…”

“…It can be speculated that severe arrhythmias are responsible for the death of some patients either before a definitive diagnosis of SAH is made or early after admission to the neurosurgical unit. 18 -3132 A systematic application of Holter monitoring should shed light on this subject.…”

Catecholamines

“…Diffuse myocytolysis, cardiac necrosis as demonstrated by elevated cardiac en zyme levels, and cardiac arrhythmias occurring in acute stroke patients may worsen neurological damage and even prove fatal (Estanol and Marin, 1975). The use of [3-blocker drugs to dampen the systemic adrenergic receptor response (Neil-Dwyer et al, 1978) following subarachnoid hemorrhage, might have paradoxical effects on the heart and brain and clearly warrants further investigation.…”

Cardiac arrhythmias in experimental subarachnoid hemorrhage.

“…It has been speculated that in some clinical cases these types of arrhythmias may be responsible for a fatal outcome. 8 6-67 Although Crompton 68 -n -"" has shown that hypothalamic lesions attributable to arterial spasm are frequently encountered in the brains of patients who died with SAH, it appears that the arrhythmias that have a time locked relationship with raised intracranial pressure are not necessarily related to the presence of blood in the subarachnoid space. These lesions, however, may be of importance in the production of those arrhythmias that have no close temporal relationship to the intracranial pressure.…”