Evaluation of incidence of acute coronary syndrome in elderly ICU patients with severe head trauma; a cohort study

Abstract

raumatic brain injury (TBI) is one of the major causes of death and disability, it is defined as an alteration in brain function, or other evidence of brain pathology, caused by an external force. TBI causes neurological and non-neurological complications. Many authors have reported that there is some sort of brain-heart interactions in the case of subarachnoid hemorrhage (SAH), ischemic or hemorrhagic cerebrovascular strokes, status epilepticus, central nervous system (CNS) infections, brain tumors and various stressful events. In blunt TBI, the heart could be affected either directly, as a part of polytrauma, or indirectly due to trauma-induced hypotension with subsequent coronary hypoperfusion. In addition, exposure to a stress-induced catecholamine surge and inflammatory mediators release in response to trauma could further jeopardize the cardiac myocytes. TBI can affect the autonomic nervous system, which in turn may lead to cardiac dysfunction. The neurocardiac axis theory and neurogenic stunned myocardium phenomenon, could partly explain the brain-heart link and interaction. The surge in catecholamine levels could lead to subendocardial ischemia, coronary artery spasm, arrhythmias, pulmonary edema, and prolonged mechanical ventilation.