Cardiac Manifestations of Subarachnoid Haemorrhage

Abstract

Background: To evaluate the cardiac manifestations of aneurysmal subarachnoid haemorrhage (SAH) in term of its effects on haemodynamics and changes in electrocardiography, echocardiography and cardiac troponin I. Methods: In this cross sectional study 96 patients, with a primary diagnosis of aneurysmal subarachnoid haemorrhage (SAH), were included . Cardiac abnormalities were defined as hypotension, pulmonary edema, ECG changes, echocardiographic wall motion abnormalities or reduction in ejection fraction below 50 percent and cardiac troponin I level above upper range of normal. Results: Mean age ±SD was 45.9±22.2. Males were 57.6%. On presentation to the emergency department pulse was 77.2±13 beats/min, systolic blood pressure 126.7±18 mmHg and diastolic blood pressure 64.7±10.2 mmHg. Eleven patients (11.1%) developed pulmonary edema during ICU stay while 14.6% developed hypotension. ECG was abnormal in 75.7%. Various abnormalities on ECG included symmetrical T wave inversion (35.5%), hyperacute T wave (13.1%), ST segment elevation (13.1%), ST segment depression (32.2%), long QT (34.3%), prominent U wave (14.1%), Sinus bradycardia (46.4%) and Sinus tachycardia (30.3%). Echocardiography showed wall motion abnormalities in 17.2% and ejection fraction was less than 50 percent in 12.1%. Cardiac troponin I was elevated in 15.6%. Conclusion: Patients with aneurysmal subarachnoid haemorrhage frequently develop cardiac injury which manifests as hemodynamic derangement, electrocardiographic changes and regional or global left ventricular dysfunction on echocardiography

Keywords

• Subarachnoid haemorrhage
• Cardiac manifestations