EKG abnormalities in central nervous system disease: Difference between revisions
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{{CMG}}; '''Associate Editor-In-Chief:''' {{CZ}} | {{CMG}}; '''Associate Editor-In-Chief:''' {{CZ}} | ||
==Overview== | ==Overview== | ||
Classic manifestations on EKG of the so-called cerebrovascular accident, (most commonly associated with subarachnoid hemorrhage or other intracranial bleeds) are deep inverted giant T wave inversion. The mechanisms are not fully delineated but may relate to excessive catecholamine stimulation causing direct myocardial injury. Takostubo syndrome may occur in some cases | Classic manifestations on EKG of the so-called cerebrovascular accident, (most commonly associated with subarachnoid hemorrhage or other intracranial bleeds) are deep inverted giant T wave inversion. The mechanisms are not fully delineated but may relate to excessive catecholamine stimulation causing direct myocardial injury. Takostubo syndrome may occur in some cases. The ECG may be notable for marked QT-U prolongation (sometimes a giant U wave appears to be appended to the T wave, creating a slight discontinuity in waveform morphology). The long QT-U may predispose to torsade(s) de pointes. Apical hypertrophic cardiomyopathy (Yamaguchi’s syndrome) is associated with deep, but relatively narrow (spade-like) T wave inversions, most marked in the mid-precordial leads. | ||
==Electrocardiographic Findings:== | ==Electrocardiographic Findings:== | ||
Revision as of 13:58, 11 August 2012
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]
Overview
Classic manifestations on EKG of the so-called cerebrovascular accident, (most commonly associated with subarachnoid hemorrhage or other intracranial bleeds) are deep inverted giant T wave inversion. The mechanisms are not fully delineated but may relate to excessive catecholamine stimulation causing direct myocardial injury. Takostubo syndrome may occur in some cases. The ECG may be notable for marked QT-U prolongation (sometimes a giant U wave appears to be appended to the T wave, creating a slight discontinuity in waveform morphology). The long QT-U may predispose to torsade(s) de pointes. Apical hypertrophic cardiomyopathy (Yamaguchi’s syndrome) is associated with deep, but relatively narrow (spade-like) T wave inversions, most marked in the mid-precordial leads.
Electrocardiographic Findings:
- EKG changes seen in 71.5% of patients with subarachnoid hemorrhage, and 57.1% of those with cerebral hemorrhage.
- Most common abnormalities are
- Large, upright, or deeply inverted T waves
- Prolongation of the QTc interval
- Prominent U waves
- Can persist for 11 days
- Rarely can ST segment elevation or depression
- Rhythm disturbances
- Reason for changes is thought to be altered autonomic tone
Examples
-
Patient with subaracnoidal hemorrhage -
EKG of a patients with CNS Disorders -
Inverted and deep T waves in the precordal leads due to subaracnoidal aneurysm [Image courtesy of Dr Jose Ganseman Dr Ganseman's webpage: An ultimate source of EKG
