Electrocardiographic abnormalities in cerebrovascular accidents.

Miura, Tetsuji; Tsuchihashi, Kazufumi; Yoshida, Eiichi; Kobayashi, Keiri; Shimamoto, Kazuaki; Ito, Osamu

doi:10.2169/internalmedicine1962.23.22

Cited by 13 publications

(19 citation statements)

References 19 publications

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“…Previous studies showed that repetitive seizures can induce remodeling of the potassium and sodium channels within the heart, leading to QTc prolongation and cardiac arrhythmias [37], and that autonomic neuropathies can prolong QTc interval in patients with primary central nervous system disease [38][39][40][41][42], autonomic neuropathy [43,44], and amyotrophic lateral sclerosis [45]. The exact mechanism by which altered nervous system control leads to cardiac arrhythmias in these cases is unknown.…”

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confidence: 99%

Rett Syndrome: Translate Medicine from Brain to Heart

Wang¹

2012

Brain Disord Ther

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Rett syndrome (RTT) is a X-linked neurodevelopmental disorder that affects approximately 1 in 10,000 live female births and is characterized by delayed-onset loss of spoken language, loss of hand use, problems with ambulation, and the development of distinctive hand stereotypes [1][2][3][4][5][6][7][8][9][10][11][12]. RTT is typically caused by mutations in methyl-CpG-binding protein 2 (MECP2) [1,2,5,[8][9][10]13,14], a gene encoding a protein involved in regulation of gene expression [3,13,15,16]. In addition to the cognitive and motor abnormalities, RTT patients also show autonomic dysfunction, with breathing and heart rate irregularities [17][18][19][20]. Boys with mutations in MECP2 show more severe autonomic dysfunction, with marked breathing and heart rate abnormalities that usually result in death within the first year of life [21]. RTT patients have a high incidence of sudden unexpected deaths (26% of all deaths) [22], which are probably of cardiac origin. Previous studies have shown that some RTT patients have prolonged QT intervals (LQT) on electrocardiograms (ECGs) [23]. In patients with other diseases, LQT is a significant risk factor for sudden arrhythmic cardiac death [24]. However, so far the causes for LQT in RTT and its contribution to the high proportion of sudden death are still unknown. As reported recently in Science Translational Medicine, McCauley et al. [25] tested the hypothesis that these sudden deaths in RTT patients may be due to cardiac dysfunction.In most cases, inherited LQT are caused by mutations in the voltage-gated potassium channels KVLQT1 (LQT1) and HERG (LQT2) and in the voltage-gated sodium channel SCN5A (LQT3) [26][27][28][29]. Rare mutations in genes encoding other channel subunits and other cardiac proteins such as caveolin-3 [30], may also contribute to some cases of inherited LQT. Since RTT patients have MeCP2 dysfunction, which causes the LQT phenotype, McCauley et al. [25] aimed at understanding whether (I) MeCP2 dysfunction in mice can recapitulate the long QT phenotype and cause predisposition to arrhythmic-induced death after programmed electrical stimulation (PES); (II) neuronal tissue specific MeCP2 dysfunction is sufficient to reproduce the LQT phenotype; and (III) alterations in the sodium current contribute to the LQT phenotype in this mouse model of RTT.Firstly, McCauley et al. [25] examined ECGs in 379 female patients with typical RTT to define the prevalence of electrophysiological abnormalities in RTT. The authors found that 18.5% of these patients had long corrected QT interval (QTc), consistent with previous reports [23,31,32]. They thought that these 18.5% of affected individuals are likely at risk for sudden death since 26% of deaths in RTT are sudden and unexpected [24]. The authors then tried to identify electrophysiological abnormalities in mouse models of RTT. They found that hemizygous male Mecp2Null/Y mice have severe early-onset LQT and QRS prolongation, and heterozygous female Mecp2 Null /+ show prolongation of both parameters that becomes...

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Rett Syndrome: Translate Medicine from Brain to Heart

Wang¹

2012

Brain Disord Ther

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“…Various ECG abnormalities are to be expected in patients with cerebral diseases. [1][2][3][4][5][6][7] Rhythm disturbances and altered repolarization in the ECG, such as QT prolongation, are the most frequent findings. It is hypothesized that these ECG abnormalities are mediated by the central nervous system as a result of the cerebrovascular event.…”

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confidence: 99%

“…[2][3][4] The few that include thromboembolic events consider thromboembolic stroke and subarachnoid hemorrhage to be a single entity despite obvious pathophysiologic differences. Few reports [5][6][7] distinguished between these two diseases and compared changes in QT interval and other ECG abnormalities. Similar to hemorrhage, QT prolongation is seen most frequently among patients with thromboembolic stroke.…”

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confidence: 99%

“…Abnormalities that are seen most frequently during the thromboembolic stroke are a prolonged QT interval and ST-T wave changes. [5][6][7] The purpose of the present study was to examine whether cardiac variables, extracted from the dynamic behavior of the uncorrected QT intervals in relation to changing RR intervals during physiotherapy effort are correlated with functional performances in patients hospitalized in a rehabilitation setting after ischemic stroke. An attempt has been made to assess the effects of brain infarction (side and depth) on autonomic cardiac regulation and to evaluate the clinical-functional significance, as measured by FIM™, of the QT-RR relationship in ischemic stroke.…”

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Dynamic Cardiophysiologic Variables Correlate with Lesion Location and FIMTM in Patients with Ischemic Stroke

Arad

Ring²,

Abboud³

et al. 2002

American Journal of Physical Medicine & Rehabilitation

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“…Abnormalities that appear most frequently during the thromboembolic stroke are prolonged QT interval and ST-T wave changes. [5][6][7] All studies on QT interval changes in stroke patients refer to the QT interval measured once at a determined heart rate and mostly at resting heart rates. Since QT length changes with heart rate, its values can be compared only after correction to a common rate, and the Bazett heart rate corrected QT (known as QT c ) is used.…”

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Effect of Ischemic Stroke on the Dynamic Beat‐to‐Beat QT‐RR Relationship

Arad

Abboud

Radai

et al. 2001

Pacing Clinical Electrophis

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The ECGs of 26 patients following ischemic stroke and 18 control patients with various orthopedic problems, all without primary heart disease, were examined to characterize the dynamic behavior of uncorrected QT interval in relation to changing RR interval during physiotherapy effort. ECG waveforms were analyzed to extract beat-to-beat QT and RR intervals. Based on performing multiple cross-correlations, the relationship between the RR and QT intervals was calculated using the following general formula QTi = c RRib-1. Linear regression was performed on the logarithms of QT and RR measurements to estimate the constant (a = log c) and the slope (b) values, reflecting the dynamic change of QT during physiotherapy effort. Having these two values, the dynamic QT extrapolated to a heart period of 1 second (QTcd) was calculated. It was found that the mean slope (b) of the linear regression line in the ischemic stroke group was significantly lower than in the control group (0.26 +/- 0.08 vs 0.33 +/- 0.08, P < 0.02), and the constant (a) was significantly higher (1.83 +/- 0.21 for the ischemic stroke vs 1.61 +/- 0.23 for the controls, P < 0.002). No significant difference was found in QTcd values between the two groups (386 +/- 27 ms for the ischemic stroke vs 392 +/- 25 ms for the controls, P > 0.05). In conclusion, hemispheric brain infarction seems to result in alteration in the autonomic activity during exercise manifesting itself as distorted dynamic behavior of the QT interval.

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Electrocardiographic abnormalities in cerebrovascular accidents.

Cited by 13 publications

References 19 publications

Rett Syndrome: Translate Medicine from Brain to Heart

Rett Syndrome: Translate Medicine from Brain to Heart

Dynamic Cardiophysiologic Variables Correlate with Lesion Location and FIMTM in Patients with Ischemic Stroke

Effect of Ischemic Stroke on the Dynamic Beat‐to‐Beat QT‐RR Relationship

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