Electrocardiographic abnormalities in acute cerebro-vascular stroke

Abstract

Acute cerebro-vascular events vary widely as regard to etiology, pathogenesis, and presentation. And several studies have reported that these events may induce central nervous system (CNS)-mediated electrocardiographic (ECG) abnormalities which occur in the absence of coexisting cardiac disease. The current study was conducted among one hundred consecutive patients admitted to stroke unit in Ain Shams University hospitals with acute ischemic stroke during the first 48 hours after onset. At the beginning of the assessment, subjects were requested for demographic data and data concerned with gender, special focus on risk factors like smoking, dyslipidemia, diabetes, hypertension, and past history of stroke. The current study aimed to detect any ECG changes among patients with ischemic cerebro vascular stroke with no past history of cardiac disease of operation or those receiving any cardiac drugs. Also patient with other types of cerebro vascular stroke are excluded from the study like intracerebral hemorrhage, subarachinoid hemorrhage and hemorrhagic stroke. The study subjects were investigated by basic laboratory data including, serum glycosylated hemoglobin percentage, lipid profile, uric acid, ESR, CRP, serum troponin and cardiac markers. In addition to basic cardiological investigations which included Echocardiography highlighting the left ventricular hypertrophy and the presence or absence of segmental wall motion abnormalities. The site of stroke is classified according to The Oxford Community Stroke Project classification (OCSP) into 4 types namely total anterior circulation infarct (TAC), lacunar infarct (LAC), partial anterior circulation infarct (PAC), and posterior circulation infarct (POC). The initial deficit and severity of the lesion in the studied subjects were estimated using the NIHSS score on admission. Each patient underwent 12 lead ECG monitoring on admission, 12 hour and 48 hours after admission and ECG changes are classified into Rhythm changes, repolarization changes and Q waves presence in one or more leads. Demographic data of patients revealed that the mean age among the study subjects (n=100) is 60.5±13.4years. Males included in the study were (63%) and females were (37%). This study showed that (52%) of the patients were hypertensive. While 11% of the patients had at least one old cerebrovascular stroke.Also percentage of patients with left ventricular hypertrophy on echocardiography was (15%). Moreover, the results of current study showed (67%) of the patients had ECG changes, (100%) of them had their changes in the first 12 hours after admission and (53.7%) of those with ECG changes had their changes transient i.e changes have disappeared before 48 hours after admission. Also the study revealed equal incidence of rhythm and repolarization changes in our sample (39%) however the most frequent ECG changes detected were T waves abnormalities 20% of the total number of sample and ST segment depression (13%) of the total sample, while the most frequent rhythm changes were ectopic beats, sinus bradycarida, AF and atrioventricular block 10% - 9% - 8% - 7% of the total sample number respectively.