Left ventricular wall motion abnormalities in subarachnoid hemorrhage: an echocardiographic study

Department of Medicine, Toronto Western Hospital, Ontario, Canada.

Although electrocardiographic (ECG) abnormalities and autopsy evidence of myocardial necrosis are associated with subarachnoid hemorrhage, their relation to in vivo measures of left ventricular function in this condition has not been established. Thirteen patients with subarachnoid hemorrhage and no prior history of heart disease were studied by two-dimensional echocardiography, performed initially 10 to 48 h (mean 18) after admission and serially for less than or equal to 14 days. Serum creatine kinase (total and myocardial isoenzyme) was determined 5 times over the first 48 h; ECGs were performed daily. Neurologic state was assessed with the use of a standard grading system. Four patients (Group I) exhibited left ventricular wall motion abnormalities in one to eight segments. In two of these patients there was also left ventricular apical mural thrombus that embolized in one patient, leading to further neurologic deterioration. The initial creatine kinase myocardial isoenzyme was higher in Group I than in Group II (patients without wall motion abnormalities) (10.3 versus 2.1 U/liter, p less than 0.001), initial heart rate was higher (91 versus 61 beats/min, p less than 0.01), neurologic grade was higher (2.5 to 4.5 versus 1 to 2, p less than 0.001) and inverted T waves were more common (4 of 4 versus 1 of 9). Three of the four patients in Group I died; two of the three underwent autopsy and were found to have no significant coronary artery disease. No other patients died.(ABSTRACT TRUNCATED AT 250 WORDS)

This article has been cited by other articles:

				E. A. Hessel II The brain and the heart. Anesth. Analg., September 1, 2006; 103(3): 522 - 526. [Full Text] [PDF]

				K. A. Bybee, T. Kara, A. Prasad, A. Lerman, G. W. Barsness, R. S. Wright, and C. S. Rihal Systematic Review: Transient Left Ventricular Apical Ballooning: A Syndrome That Mimics ST-Segment Elevation Myocardial Infarction Ann Intern Med, December 7, 2004; 141(11): 858 - 865. [Abstract] [Full Text] [PDF]

				Y.J. Akashi, H. Musha, K. Nakazawa, and F. Miyake Plasma brain natriuretic peptide in takotsubo cardiomyopathy QJM, September 1, 2004; 97(9): 599 - 607. [Abstract] [Full Text] [PDF]

				Y. J. Akashi, K. Nakazawa, M. Sakakibara, F. Miyake, H. Musha, and K. Sasaka 123I-MIBG Myocardial Scintigraphy in Patients with "Takotsubo" Cardiomyopathy J. Nucl. Med., July 1, 2004; 45(7): 1121 - 1127. [Abstract] [Full Text] [PDF]

				C. Van Mieghem, M. Sabbe, and D. Knockaert The Clinical Value of the ECG in Noncardiac Conditions Chest, April 1, 2004; 125(4): 1561 - 1576. [Abstract] [Full Text] [PDF]

				Y C Fu, C S Chi, Y T Chiu, S L Hsu, B Hwang, S L Jan, P Y Chen, F L Huang, and Y Chang Cardiac complications of enterovirus rhombencephalitis Arch. Dis. Child., April 1, 2004; 89(4): 368 - 373. [Abstract] [Full Text] [PDF]

				W. M. van den Bergh, A. Algra, and G. J.E. Rinkel Electrocardiographic Abnormalities and Serum Magnesium in Patients With Subarachnoid Hemorrhage Stroke, March 1, 2004; 35(3): 644 - 648. [Abstract] [Full Text] [PDF]

				Y.J. Akashi, K. Nakazawa, M. Sakakibara, F. Miyake, H. Koike, and K. Sasaka The clinical features of takotsubo cardiomyopathy QJM, August 1, 2003; 96(8): 563 - 573. [Abstract] [Full Text] [PDF]

				D. Arab, A. M. Yahia, and A. I. Qureshi Cardiovascular Manifestations of Acute Intracranial Lesions: Pathophysiology, Manifestations, and Treatment J Intensive Care Med, May 1, 2003; 18(3): 119 - 129. [Abstract] [PDF]

				T. Masuda, K. Sato, S.-i. Yamamoto, N. Matsuyama, T. Shimohama, A. Matsunaga, S. Obuchi, Y. Shiba, S. Shimizu, and T. Izumi Sympathetic Nervous Activity and Myocardial Damage Immediately After Subarachnoid Hemorrhage in a Unique Animal Model Stroke, June 1, 2002; 33(6): 1671 - 1676. [Abstract] [Full Text] [PDF]

				Y J Akashi, M Sakakibara, and F Miyake Reversible left ventricular dysfunction "takotsubo" cardiomyopathy associated with pneumothorax Heart, February 1, 2002; 87 (2): e1 - e1. [Abstract] [Full Text] [PDF]

				P. J. Hauptman, K. J. O'Connor, R. E. Wolf, and B. J. McNeil Angiography of potential cardiac donors J. Am. Coll. Cardiol., April 1, 2001; 37(5): 1252 - 1258. [Abstract] [Full Text] [PDF]

				J. G. Zaroff, G. A. Rordorf, J. S. Titus, J. B. Newell, N. J. Nowak, D. F. Torchiana, H. T. Aretz, M. H. Picard, and R. L. Macdonald Regional Myocardial Perfusion After Experimental Subarachnoid Hemorrhage Editorial Comment Stroke, May 1, 2000; 31(5): 1136 - 1143. [Abstract] [Full Text] [PDF]

				S. A. Mayer, J. Lin, S. Homma, R. A. Solomon, L. Lennihan, D. Sherman, M. E. Fink, A. Beckford, and L. M. Klebanoff Myocardial Injury and Left Ventricular Performance After Subarachnoid Hemorrhage Stroke, April 1, 1999; 30(4): 780 - 786. [Abstract] [Full Text] [PDF]

				P. J. Hauptman and K. J. O'Connor Procurement and Allocation of Solid Organs for Transplantation N. Engl. J. Med., February 6, 1997; 336(6): 422 - 431. [Full Text] [PDF]

				D. S. Pine and L. Tierney A Stressful Interaction N. Engl. J. Med., June 6, 1996; 334(23): 1530 - 1534. [Full Text] [PDF]

				A. M. Elrifai, J. E. Bailes, S.-R. Shih, S. Dianzumba, and J. Brillman Characterization of the Cardiac Effects of Acute Subarachnoid Hemorrhage in Dogs Stroke, April 1, 1996; 27(4): 737 - 742. [Abstract] [Full Text]

				J. A. Miller, R. G. Dacey Jr, and M. N. Diringer Safety of Hypertensive Hypervolemic Therapy With Phenylephrine in the Treatment of Delayed Ischemic Deficits After Subarachnoid Hemorrhage Stroke, December 1, 1995; 26(12): 2260 - 2266. [Abstract] [Full Text]