Hema, M (2010) A Study of Electrocardiographic Changes in Acute Cerebrovascular Accidents. Masters thesis, Stanley Medical College, Chennai.
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Abstract
INTRODUCTION: Cushing first described hemodynamic changes after acute intracerebral hemorrhage. Cardiac abnormalities were described with various CNS diseases including seizures, trauma, ischemic stroke, ICH and less commonly tumors, electroconvulsive therapy and meningitis. More recently emotion and stress induced cardiomyopathy has been described. The anatomy and physiology of pathways involved in brain-heart interaction have been elucidated in both animal and human studies. The ability to reproduce the arrhythmia by activation of the sympathetic nervous system suggested a neurogenic mechanism. The medulla has been described as the principal site of vagal parasympathetic and sympathetic areas involved in cardiac control. In addition both anatomical and physiological evidences implicate the hypothalamus in cardiac control. Electrical stimulation experiments suggests a posteriorly located area of cardiovascular sympathetic control and anterior parasympathetic control region. Beattie an colleagues first described cardiac arrhythmias after hypothalamic stimulation. Arrhythmias from hypothalamic stimulation were subsequently confirmed in other animal models. Areas of cerebral cortex with connection to autonomic nervous can also elicit cardiac response. The autonomic – emotional interaction with cardiovascular function have been linked to central nucleus of amygdale. Stimulation of orbito frontal, cingulated and temporal regions can elicit a cardiac response. Majority of evidence suggests that the insular cortex has a pivotal role in integrating autonomic response and is strongly associated with adverse cardiac events after neurological injury. AIM OF THE STUDY: 1. To study the incidence and pattern of ECG changes in patient with cerebrovascular accidents. 2. To study the association of ECG changes with electrolytes abnormalities and 3. To assess the relation of ECG changes in acute cerebrovasular accident to the location of cerebral lesion. MATERIAL AND METHODS: Study Population: The study was conducted at Government Stanley Hospital during the year 2008 to 2009 on all patients admitted to medical ward with acute cerebrovascular accidents. Study population consisted of 50 patients. This is an observational study. Inclusion Criteria: All patients with acute cerebrovascular accidents. Exlusion Criteria: Patients with underlying heart diseases. Patients on drugs. Previously diagnosed patients with electrolyte abnormalities. Patient with hepatic or renal diseases. METHODOLOGY: All patients with acute cerebrovascular accidents were studied. They were assessed with serum electrolytes, X ray and blood urea and sugar 12 lead ECG was taken and monitored on the day of admission. CT scan was taken within 24-48 hrs. Screening ECHO was done on all patients with ECG changes. Patients showing cardiomegaly on X ray were excluded from the study. Patients previously diagnosed to have electrolyte abnormalities were also excluded from the study. Patients were categorized based on the CT finding as cerebral infarction, cerebral hemorrhage and sub- arachnoid hemorrhage. ECG was then interpreted with rate, rhythm, ST segment, QRS complex, T wave amplitude and morphology and QT interval was calculated. QTC interval was calculated based on Bazetts formulae. CONCLUSION: Of all the CVA patients assessed in this study, ECG changes of all forms were noted in as high as 78% of the patients. ECG changes were more commonly associated with intracerebral hemorrhage compared with cerebral infarction. ST segment changes were the most common abnormality noted in our study. It was most commonly associated with ICH. Next common abnormality noted was QTc prolongation which was noted in 50% of patient. Most common in patients with ICH. T wave changes were noted in 45% of patients. Most commonly observed in patients with ICH. Tall T wave was noted mostly in ICH. Rhythm disturbance were noted in 40% percent of patients with ICH. Sinus bradycardia was the common abnormality associated with ICH. 7% percent of the patients with cerebral infarction had pathological Q waves. None of the patients in our study had associated electrolyte abnormalities. These ECG changes were not associated with any particular site of cerebral lesion. Cardiac disturbance are diverse and frequent in the setting of acute neurological injury. More importantly the presence of cardiac abnormalities has significant impact on clinical management and affects cardiac and neurological outcome. Understanding that these ECG changes which are occurring in patients with CVA is important because it may lead to erroneous judgment of assigning these patients as CAD. These patients should be evaluated for cardiac injury and treated only if necessary.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Electrocardiographic Changes ; Acute Cerebrovascular Accidents. |
| Subjects: | MEDICAL > General Medicine |
| Depositing User: | Subramani R |
| Date Deposited: | 23 Mar 2018 17:18 |
| Last Modified: | 24 Mar 2018 11:48 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/6521 |
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