EKG abnormalities in central nervous system disease

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Electrocardiographic Findings:

1. EKG changes seen in 71.5% of patients with subarachnoid hemorrhage, and 57.1% of those with cerebral hemorrhage.
2. Most common abnormalities are
   • Large, upright, or deeply inverted T waves
   • Prolongation of the QTc interval
   • Prominent U waves
3. Can persist for 11 days
4. Rarely can ST segment elevation or depression
5. Rhythm disturbances
   • Sinus bradycardia
   • Sinus tachycardia
   • Wandering atrial pacemaker
   • AV junctional rhythm
   • Premature ventricular contractions PVCs
   • Ventricular tachycardia (VT)
6. 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

v • d • e Electrocardiography
Overview	History of the EKG • EKG interpretation basics • Normal sinus rhythm
EKG Complexes	P wave • QRS complex • ST Segment • T wave • U wave Osborn wave • H wave • K wave • Delta wave NSSTW changes
EKG Intervals	PR Interval • QRS Interval • ST Interval • QT Interval
Conduction System & Bradycardia	Cardiac pacemaker • SA node • AV node• Bundle of His • Purkinje fibers • Sinus bradycardia • First Degree AV Block • Second Degree AV Block • Complete or Third-Degree AV Block • Concealed conduction • AV Junctional Rhythms • LBBB • LAHB • LPHB • RBBB • Trifascicular block
Atrial Arrhythmias	Sinus tachycardia • Premature Atrial Contractions (PACs) • Ectopic Atrial Rhythm • Paroxysmal Atrial Tachycardia (PAT) • Paroxysmal Atrial Tachycardia (PAT) with Block • Multifocal Atrial Tachycardia (MAT) • Atrial Flutter • Atrial Fibrillation • Wandering atrial pacemaker
Ventricular Arrhythmias	Differential Diagnosis of Tachycardia with a Wide QRS Complex • Accelerated Idioventricular Rhythm • Ventricular Parasystole • Premature Ventricular Contractions (PVCs) • Ventricular tachycardia • Ventricular Fibrillation • Sudden cardiac death
EKG Abnormalities in Disease States	Hypertrophy & Dilatation • Right atrial enlargement • Left atrial enlargement • Biatrial enlargement • Left Ventricular Hypertrophy • Right Ventricular Hypertrophy • Biventricular Hypertrophy • Acute myocardial infarction • NSTEMI • STEMI • Right ventricular myocardial infarction • Atrial infarction Pre-excitation Syndromes • Wolff-Parkinson-White Syndrome • Lown Ganong Levine Syndrome • Mahaim Type Preexcitation Cardiomyopathies • Arrhythmogenic Right Ventricular Dysplasia • Dilated Cardiomyopathy • Hypertrophic Cardiomyopathy Drug Effects on the EKG • Adenosine • β-blockers • Digitalis • Quinidine • Procainamide • Disopyramide • Lidocaine • Tocainide and Mexiletine • Phenytoin • Encainide, Flecainide and Propafenone • Amiodarone • Bretylium • Ca Channel Blockers • Phenothiazines • Tricyclic Antidepressants • Lithium Congenital Heart Disease • Dextrocardia • Atrial Septal Defect • Ventricular Septal Defect • Tetralogy of Fallot • Conjoined Twins or Siamese Twins • Congenital heart block Electrolyte Disturbances • Hyperkalemia • Hypokalemia • Hypercalcemia • Hypocalcemia • Nonspecific Changes Other Heart Diseases • Pericarditis • Myocarditis • Tamponade • Heart Transplantation • Sick Sinus Syndrome • Long QT Syndrome Inherited Disease • Brugada Syndrome Systemic Diseases • CNS Disease • Cardiac Tumors Heart Transplantation • EKG Changes in patient with Heart Transplantation Exogenous Effects • Hypothermia • Chest Trauma • Insect Bites • Electric Injuries
Technical Issues and Potential Errors in Interpretation	Artifacts • Lead Placement Errors • The EKG in a Patient with a Pacemaker • EKG in athletes

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Articles on EKG abnormalities in central nervous system disease	Most recent articles on EKG abnormalities in central nervous system disease • Most cited articles on EKG abnormalities in central nervous system disease • Review articles on EKG abnormalities in central nervous system disease • Articles on EKG abnormalities in central nervous system disease in N Eng J Med, Lancet, BMJ
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Evidence Based Medicine Regarding EKG abnormalities in central nervous system disease	Cochrane Collaboration on EKG abnormalities in central nervous system disease • Bandolier on EKG abnormalities in central nervous system disease • TRIP on EKG abnormalities in central nervous system disease
Cost Effectiveness of EKG abnormalities in central nervous system disease	Cost Effectiveness of EKG abnormalities in central nervous system disease
Clinical Trials Involving EKG abnormalities in central nervous system disease	Ongoing Trials on EKG abnormalities in central nervous system disease at Clinical Trials.gov • Trial results on EKG abnormalities in central nervous system disease • Clinical Trials on EKG abnormalities in central nervous system disease at Google
Guidelines / Policies / Government Resources (FDA/CDC) Regarding EKG abnormalities in central nervous system disease	US National Guidelines Clearinghouse on EKG abnormalities in central nervous system disease • NICE Guidance on EKG abnormalities in central nervous system disease • NHS PRODIGY Guidance • FDA on EKG abnormalities in central nervous system disease • CDC on EKG abnormalities in central nervous system disease
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Patient Resources on EKG abnormalities in central nervous system disease	Patient resources on EKG abnormalities in central nervous system disease • Discussion groups on EKG abnormalities in central nervous system disease • Patient Handouts on EKG abnormalities in central nervous system disease • Directions to Hospitals Treating EKG abnormalities in central nervous system disease • Risk calculators and risk factors for EKG abnormalities in central nervous system disease
Healthcare Provider Resources on EKG abnormalities in central nervous system disease	Symptoms of EKG abnormalities in central nervous system disease • Causes & Risk Factors for EKG abnormalities in central nervous system disease • Diagnostic studies for EKG abnormalities in central nervous system disease • Treatment of EKG abnormalities in central nervous system disease
Continuing Medical Education (CME) Programs on EKG abnormalities in central nervous system disease	CME Programs on EKG abnormalities in central nervous system disease
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