Life-Threatening Arrhythmias in Subarachnoid Hemorrhage

182

100

The frequency and severity of cardiac arrhythmias were studied in 70 patients with spontaneous subarachnoid hemorrhage investigated prospectively with 24-hour Hotter monitoring. Patients were < 70 years old and without clinical and/or ECG signs of previous heart disease; Hoi ter monitoring was initiated within 48 hours of subarachnoid hemorrhage. Arrhythmias were detected in 64 of the 70 patients (91%). Twenty-nine of the 70 patients (41%) showed serious cardiac arrhythmias; malignant ventricular arrhythmias, i.e., torsade de pointe and ventricular flutter or fibrillation, occurred in 3 cases. Serious ventricular arrhythmias were associated with QTc prolongation and hypokalemia. No correlation was found between the frequency and severity of cardiac arrhythmias and the neurologic condition, the site and extent of intracranial blood on computed tomography scan, or the location of ruptured malformation. The extremely high incidence of cardiac arrhythmias, sometimes serious, in the acute period after subarachnoid hemorrhage and the absence of clinical and radiologic predictors make systematic continuous ECG monitoring compulsory to improve the overall results of subarachnoid hemorrhage, irrespective of early or delayed surgical treatment. (Stroke 1987; 18:558-564)

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Andreoli¹,

Pasquale²,

Pinelli³

et al. 1987

182

100

“…In regard to the treatment of these disorders, the few arrhythmias reported in the literature responded well to the standard methods of treatment for arrhythmias of other causes. 24 However, chemical blockage of the sympathetic and parasympathetic systems with atropine and propranolol has been advocated for the prevention of myocardial damage in patients with intracranial hemorrhage. 22 ' 49> 50 It is probably significant that these patients and three others reported in the literature 2325 had bizarre atrial and ventricular arrhythmias similar to those reported in the experimental animal by Hockman et al 34 Also, from the cases isolated from the literature in which the location of the aneurysm was known, two cases 23 ' 27 had aneurysms of the anterior communicating artery, and at least three cases 23 (and those reported here) had aneurysms of the posterior communicating in the junction with the internal carotid.…”

Section: Syndromementioning

confidence: 99%

“…Moreover, when there is a concomitant impairment of consciousness and no clinical history, the disturbance of the cardiac rhythm may appear to be the primary illness of these patients. 23 Parizel 24 described two cases of spontaneous SAH, both of which developed several different arrhythmias within a short period of time: supraventricular tachycardia, short bursts of ventricular premature beats, multifocal ventricular tachycardia, ventricular flutter and ventricular fibrillation necessitating D.C. countershock and intravenous antiarrhythmic drugs. Both patients survived.…”

mentioning

confidence: 99%

Cardiac Arrhythmias and Sudden Death in Subarachnoid Hemorrhage

Estañol

Marin

1975

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.

“…Parizel 25 reported the occurrence of circulatory arrest due to ventricular fibrillation in two patients with subarachnoid hemorrhage. In patients with subarachnoid hemorrhage, the following arrhythmias also have been reported: wandering atrial pacemaker, 9 …”

Section: Cardiac Arrhythmias In Patientsmentioning

confidence: 99%

Myocardial Damage and Cardiac Arrhythmias After Intracranial Hemorrhage. A Critical Review

Weidler

1974

111

Evidence is presented which supports the theory that intracranial hemorrhage may secondarily cause myocardial damage and cardiac arrhythmias. Fatal intracranial hemorrhage occasionally is accompanied by ECG changes which are consistent with myocardial infarction; histological examination of the heart revealed a variable amount of myocardial damage. After intracranial hemorrhage in animals, myocardial damage was frequent. Similar myocardial damage was produced in animals by intravenous infusion of norepinephrine or acetylcholine and by electrical stimulation of the stellate ganglia, vagus nerve or mesencephalic reticular formation. Atrial and ventricular arrhythmias and various degrees of A-V block were reported in patients suffering from subarachnoid hemorrhage. Similar cardiac arrhythmias were found in animals after intracranial hemorrhage, and with electrical stimulation of the vagus nerve, stellate ganglia or CNS centers. Available data suggest that increased or altered autonomic activity may be the mechanism whereby intracranial hemorrhage produces myocardial damage and cardiac arrhythmias. The efficacy of autonomic blockade in preventing myocardial damage, which was secondary to experimental intracranial hemorrhage in animals, was demonstrated. It is suggested that the initiation of therapy with autonomic blocking drugs, as soon as possible after the onset of intracranial hemorrhage in patients, may be useful in preventing myocardial damage and cardiac arrhythmias.