Electrocardiographic changes and their prognostic significance in subarachnoid haemorrhage

Abstract

In a study on the prognostic significance of catecholamine linked ECG changes in 40 cases of subarachnoid hemorrhage, there were 16 men of mean age 41 yr (range 13 to 56) and 24 women of mean age 42 yr (range 11 to 65). There were 6 deaths, and 5 of these patients had consistently abnormal ECGs. Analysis of the abnormal components of ECGs revealed that the presence of either a pathological Q wave or a raised S-T segment indicated a poor prognosis. The 2 patients with pathological Q waves died, and the 3 patients with raised S-T segments all developed cerebral arterial spasm, 1 of whom died. A high incidence of peaked P waves, short P-R intervals, a long Q-Tc, and tall U waves occurred in the ECGs of 6 patients who died, the 15 patients with cerebral arterial spasm, and the 7 patients who were later to develop cerebral arterial spasm. Three of the latter eventually died, in contrast with the single death in the 22 patients who did not develop cerebral arterial spasm and had a low incidence of P wave peaking, short P-R intervals, a long Q-Tc, and tall U waves. Various combinations of these 4 ECG changes, in addition to peaking of the T wave, indicated a bad prognosis irrespective of the type of treatment. The criteria for prognosis on the role of catecholamines in causing the ECG abnormalities are discussed.