Dead sea like giant negative t wave associated with subarachnoid hemorrhage
Subarachnoid hemorrhage is a catastrophic neurological event. Rupture of an aneurysm results it. In addition to neurological signs and symptoms ECG abnormalities reported. These ECG findings reported are prolonged QTc, ST segment abnormalities, T wave inversion, abnormal U wave, bradicardia, tachicardia, Premature ventricular complex, Premature atrail complex, atrial fibrilation, VT, AV blocks. We described a patient with subarachnoid hemorrhagae showed giant inverted T wave.
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Introduction
Case Report
Discussion
T wave is the electrocardiographic manifestation of ventricular repolarization. Any reason disrupting ventricular repolarisation just like acute coranary syndromes, left ventricular hypertrophy, pulmonary embolism, electrolyte disturbances and cerebrovascular events eventuate T wave abnormalities. Subarachnoid hemorrhage is usually accompanied by electrocardiographic abnormalities including the T-wave abnomalities he and it’s thought that these changes are caused by increased sympathetic and vagal tone leading to aberrant repolarisation, probably secondary to myocyte injury and contraction band necrosis.1 Neurogenic ECG alterations are often transient. It causes diagnostic problems, ECG findings in neurogenic problems can mimic acute myocardial infarction. It is important to avoid inappropriate therapies. An imbalance of autonomic cardiovascular control and increased circulating local myocardial tissue catecholamines. Several experience investigation reported that a sudden increase in intracranial pressure occurs that a massive sympathetic discharge.2,3 Experimental studies suggest that a large amount of norepinephrin is released during sudden neurologic problems. Alterations in cardiac depolarisation and repolarisation reported 74% of patient with cerebrovascular events.4
Experimental studies impilicates that insular cortex is responsible in cardiovascular control and heart chronotropik organisation. Studies suggest that its involvement occurs neurogenic ECG alterations.5 Porter et al.6 found that stimulation of the posterolateral hypothalamus not only induced rhythm abnormalities but also caused repolarisation changes. Attar and collegues found that stimulation of the anterior hypothalamus produced ST elevation and deepening of T waves.7 Thus, hypothalamic stimulation is capable of causing both arrhythmias and a variety of ECG changes which mimic acute myocardial injury or ischemia. In a study by Estanol et al.8 rhythm and repolarisation changes were created in dogs by introducing blood into the subarachnoid space.
References
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