EKG abnormalities in central nervous system disease

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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 accidents, (most commonly associated with subarachnoid hemorrhage or other intracranial bleeds) are symmetrically and deeply inverted giant T waves.

Pathophysiology

The mechanisms are not fully delineated but may relate to excessive catecholamine stimulation causing direct myocardial injury (myocytolysis).

Diagnosis

Electrocardiographic Findings

The ECG may be notable for marked QT-U prolongation (sometimes a giant U wave appears to be embeded in the T wave, creating a slight discontinuity in the waveform morphology). The long QT-U may predispose to torsade(s) de pointes. Takostubo syndrome may occur in some cases. Apical hypertrophic cardiomyopathy (Yamaguchi’s syndrome) is associated with deep narrow (spade-like) T wave inversions, most marked in the mid-precordial leads.

  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
  3. Can persist for 11 days
  4. Rarely can ST segment elevation or depression
  5. Rhythm disturbances
  6. Reason for changes is thought to be altered autonomic tone

Examples

Refrences



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