SUBARACHNOID HEMORRHAGE - ELECTROCARDIOGRAPHIC, LEFT-VENTRICULAR WALL-MOTION ABNORMALITIES AND MORTALITY ANALYSIS IN 14 CASES

BACKGROUND: Electrocardiographic (ECG) changes have been frequently ob served in patients with subarachnoid hemorrhage (SAH), Their associati on with wall motion abnormalities of the left ventricle (LV) have not been well established. PATIENTS AND METHODS: Sixteen patients with SAH were included; 2 patients with previous history of heart disease were subsequently excluded, We studied the neurological damage (Hunt-Hess grading scale), ECG (ST segment, T wave) and echocardiography (LV regi onal and global contractility) of 14 patients. RESULTS: The ECG was ab normal in 11 patients (T wave: 6 patients; ST segment: 5 patients). Ec hocardiography showed alterations in 5 patients, all of them with ECG changes (T wave: one patient; ST segment: 4 patients). The neurologica l lesion was higher in patients with abnormal echocardiogram (Hunt-Hes s mean grade: 4.6 vs 2.7 in patients with normal echocardiogram; p < 0 .001). An intravenous infusion of dobutamine in a 23 years old male, i mproved the LV ejection fraction, which was severely depressed at base line. Mortality, in all cases secondary to the neurological damage, wa s higher in patients with abnormal ECG (91% vs 0% in patients with nor mal EGG; p = 0.01) and when the echocardiogram showed alterations alth ough in the last case no statistical diferences were found. CONCLUSION S: Echocardiography abnormalities in patients with SAH and without pre vious history of heart disease are more frequently related to ECG chan ges affecting ST segment, and to a higher cerebral damage.