G. Lanzino et al., ELECTROCARDIOGRAPHIC ABNORMALITIES AFTER NONTRAUMATIC SUBARACHNOID HEMORRHAGE, Journal of neurosurgical anesthesiology, 6(3), 1994, pp. 156-162
Electrocardiographic (ECG) abnormalities and rhythm disorders are freq
uently observed in the acute phase after spontaneous subarachnoid hemo
rrhage (SAH). These abnormalities are benign and transient in most cas
es; however, in some patients they can take the form of life-threateni
ng arrhythmias such as ventricular flutter/fibrillation and torsade de
pointe. Among the ECG abnormalities observed, prolongation of the Q-T
interval, especially if associated with hypokalemia, deserves particu
lar attention because it is frequently present in those patients who w
ill develop fife-threatening ventricular arrhythmias. In some cases, t
he ECG abnormalities mimic those observed in the setting of acute myoc
ardial infarction. Elevated creatine phosphokinase-myocardial fraction
isoenzyme, suggesting underlying cardiac damage, has also been report
ed. The pathophysiology of these abnormalities is related to an imbala
nce of autonomic cardiovascular control. Because some electrical and m
orphological heart abnormalities are experimentally induced by catecho
lamine injection, the role of circulating catecholamines has been inve
stigated in depth. Pathologically, the hearts of patients who die afte
r SAH can show a peculiar morphological lesion defined as ''myocytolys
is.'' Intramyocardial hemorrhages have also been described. These obse
rvations confirm the utility of continuous cardiac monitoring in patie
nts with SAH.