Relation of ECG changes to neurological outcome in patients with aneurysmal subarachnoid hemorrhage.

BACKGROUND: Electrocardiographic (ECG) alterations occurring during the course of subarachnoid hemorrhage (SAH) have been described frequently, but the incidence, patterns, and prognostic significance are not well defined. This study was designed to investigate these features. METHODS: All patients admitted to a 31-bed department of intensive care between 1993 and 2000 with acute aneurysmal SAH documented by cerebral angiography or autopsy were included. Patient charts were reviewed retrospectively, and an observer blinded to the patients' clinical course and outcome reviewed the ECGs. In-hospital mortality and outcome as assessed by the Glasgow outcome score were noted. RESULTS: Of 159 patients (49.6 years [range: 20-75]) with acute SAH, 106 (66.7%) had abnormal ECGs (classified by an observer blinded to the patients' clinical course and outcome. Conduction abnormalities were present in 7.5%. Arrhythmias occurred in 30.2%. By univariate analysis, the presence of ST depression was related to outcome as assessed by the Glasgow Outcome Scale (GOS) (15% poor outcome [GOS 4-5] vs. 1% good outcome [GOS 1-3], p<0.05). However, by multivariate analysis, none of the ECG alterations was related to outcome. ST depression was related to the APACHE II score, Hunt and Hess scale, and the WFNS score. ECG abnormalities were not related to the development of vasospasm or increased intracranial pressure. CONCLUSIONS: In patients with acute aneurysmal SAH, repolarization abnormalities are the commonest ECG alterations, and ST depression is more common in patients with poor outcome. However, ECG alterations are not independently related to outcome.

Cardiac manifestations after subarachnoid hemorrhage: a systematic review of the literature.

Cardiac alterations associated with subarachnoid hemorrhage (SAH) have been recognized and frequently reported. We systematically reviewed the literature on MEDLINE using the key words: SAH + (heart, cardiac, electrocardiogram, cardiac enzymes, troponin, myoglobin, echocardiography, scintigraphy, Holter, and regional wall motion abnormalities) and included all articles describing cardiac abnormalities in the course of SAH whether spontaneous or secondary. The diagnosis of SAH was established by computed tomography scan, lumbar puncture, or brain autopsy. Cardiac abnormalities were identified by electrocardiogram, enzymatic elevation, Holter monitoring, echocardiography, cardiac scintigraphy, coronary angiography, or autopsy. Despite the considerable literature describing cardiac alterations during the course of SAH, epidemiological, pathophysiological, and prognostic aspects are yet to be clarified. Further studies are needed to evaluate the magnitude of this problem.