Junctional bradycardia caused by subarachnoid hemorrhage

Abstract

The electrocardiogram in subarachnoid hemorrhage patient is in many ways. A 69-year-old female felt headache and then collapsed an hour prior to arrival of emergency room. Her vital signs were a body temperature of 37 °C, heart rate of 51 beats per minute, and blood pressure of 224/135 mm Hg. Physical examinations revealed comatose with Glasgow Coma Scale E1V1M1 and fast glucose level test showed 238 mg/dl. Initial electrocardiogram (ECG) revealed junctional bradycardia (51 beats per minute) with T inversion over lead V2 to V6. Cranial computed tomography (CT) scan was performed and revealed diffuse subarachnoid hemorrhage (SAH) in the subarachnoid cisterns, bilateral sylvian fissures, left frontal sulci, left temporal cortical sulci, and interhemispheric fissure as well as lateral, third and fourth ventricles. External ventricular drainage was placed by neurosurgeon and patient was then admitted to intensive care unit. She was discharged with a bedridden and aphasic status 32 days later. Repolarization abnormalities, such as ST-segment change, T wave inversion and QTc prolongation, are also commonly seen in ECGs of patients with SAH. Physicians should keep in mind of junctional bradycardia not certainly as a cardiac problem, it may appear in cranial emergency.

Keywords

• Electrocardiogram
• Junctional bradycardia
• Inverted T wave
• Subarachnoid haemorrhage