DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20161979

A study of electrocardiogram changes in patients with acute stroke

Surender Kumar, Guru Dutt Sharma, Varan Deep Dogra

Abstract


Background: Electrocardiogram (ECG) changes are observed in patients with acute stroke and may create confusion with ECG changes found in cardiac disorders. The aim of the study was to study the ECG changes in patients with acute stroke who are not suffering from cardiac disorders which are known to show ECG changes.

Methods: It was a prospective hospital observational based study conducted for a period of 1 year (20th July 2014 to 20thJuly 2015) including patients with acute stroke. Total 122 patients were enrolled and ECG changes were observed.

Results: Various ECG changes are observed (Table 1) in present study including rhythm disturbances (like sinus tachycardia, sinus bradycardia, AF, VPc, RBBB, LBBB, etc.)  in 69 patients (56.6%) , bradycardia in 25 patients (19.5%), tachycardia 34 patients (28.1%), prolonged PR interval in 10 patients (9.2%), LAD in 32 patients (26.2%), RAD in 7 patients (5.7%), prolonged QRS interval in 31 patients (25.4%), LVH in 19 patients (15.6%), prolonged QTc interval in 53 patients (43.4%), p wave abnormalities in 30 patients (24.6%), pathological q wave in 11 patients (9.6%), ST segment elevation in 14 patients (11.4%), ST segment depression in 20 patients (16.4%), T wave inversion in 44 patients (36.1%) and presence of U wave in 9 patients (7.1%).

Conclusions: QTc prolongation followed by T-wave inversion followed by ST segment changes were the most frequent ECG changes observed in patients with acute stroke. Various types of arrhythmias like sinus tachycardia, sinus bradycardia, AF, VPCs, BBB, Heart blocks, etc. were also among the common ECG findings. Furthermore ECG findings like PR interval prolongation, QRS interval prolongation and P-wave abnormalities (hardly any study is there in literature about these ECG findings) were additional findings in this study.

 


Keywords


ECG, Acute stroke, NCCT head

Full Text:

PDF

References


Smith WS, English JD and Johnston SC. In: Longo DL, Fauci AS, Kasper DL, Hauser, Jameson JL, Loscalzo J, editors. Harrrison`s principles of internal medicine. 18th ed. New York: McGraw-Hill. 2011;370:3270.

Ince B, Celik Y, Bingol H, Harmanci H, Denktas H. Electrocardiographic findings and prognosis inischemic stroke. Cerrahpasa J Med. 1998;29:70-4.

Fentz V, Gormsen J. Electrocardiograph patterns in patients with acute cerebrovascular accidents. Circulation. 1962;25:22-8.

Oppenheimer SM, Hachinski V. The cardiac consequences of stroke. Neurol Din. 1992;10:167-76.

Melville KI, Blum B, Shistr HE. Cardiac ischemic changes and arrhythmias induced by hypothalamic stimulation. Am J Cardiol. 1963;12:78.

Anand K, Chowdhury D, Singh KB, Pandav CS, Kapoor SK. Estimation of mortality and morbidity due to stroke in India. Neuroepidemiology. 2001;20:208-11.

Cropp D, Manning GW. Electrocardiographic changes simulating myocardial ischemia and infarction associated with spontaneous intracerebral hemorrhage. Circulation. 1980;12:25.

Venkatesan S, Rare skills in medicine: Diagnosing stroke with the help of electrocardiogram. Editor Venkatesan S. 2010;11:28.

Goldstein DS. The electrocardiogram in stroke: Relationship to pathophysiological type and comparison with prior tracings. Stroke. 1979;10:253-9.

Akbar MA, Awan MM, Haider SA, Choudhry GM. Stroke; electocardiographic changes, Professional Med J Mar. 2008;15(1):91-5.

Stober T. Cardiac arrhythmias in subarachnoid hemorrhage. Acta Neurochir. 1998;93:37-44.

Bozluoclay M, Ince B, Celik Y, Harmanci H, Llerigelen B, Pelin Z. Electrocrdiographic findings and prognosis inischemic stroke. Neurol Ind. 2003;51:500-2.

Arruda WO. Electrocardiographic findings in acute cerebrovascular hemorrhage. Arq Neuro-psiquiat (sao paulo). 1992;50(3):269-74.

Ebrahim K, Mohamadali A, Majid M, Javad A. ECG changes in acute ischemic cerebral stroke. The Journal of Applied Research. 2012;12(1).

Byer E, Ashman R, Toth LA. Electrocardiogram with large upright T waves and long QT intervals. Am Heart J. 1947;33:796-806.

Rudehill A, Gordon E, Sylven C. A study of ECG abnormalities and myocardial specific enzymes in patient with subarachnoid hemorrhage. Acta Anaesth Scand. 1982;26:344-50.