SESSION TYPE: Neuro Critical Care
PRESENTED ON: Tuesday, October 23, 2012 at 04:30 PM - 05:45 PM
PURPOSE: Subarachnoid hemorrhage (SAH) can be complicated by abnormal electrocardiograms, conduction disturbances and neurogenic pulmonary edema due to cardiac suppression or “stunning” from release of catecholamines. Management of volume status and vasospasm prevention is evolving quickly. We reviewed cardiovascular morbidity of SAH patients admitted over one year to our Neurointensive care unit.
METHODS: A retrospective chart review of all adult patients admitted with SAH. Data collection included demographics, Hunt & Hess (H&H) grade, troponin, ECHOcardiography (ECHO), ECG, prophylactic magnesium sulfate infusion and the development of pulmonary edema
RESULTS: There were 33 patients with SAH: 17 male (51%), 16 female (48%), mean age 55 years. A history of hypertension was common (45%), diabetes mellitus less common (9%). H&H grades were: 30% Grade 1 (10), 27% Grade 2 (9), 15% Grade 3 (5), 3% Grade 4 (1), and 24% Grade 5 (8). ECG abnormalities were common: 39%(13) exhibited new T-wave abnormalities, 36%(12) demonstrated bradycardia, and 12% (4) had ST segment abnormality . Pulmonary edema occurred in 10 (30%) patients. Three patients with pulmonary edema had positive troponins, 2 demonstrated impaired systolic or diastolic dysfunction, 4 had normal left ventricular function (no data available on four patients). H&H grade for patients with pulmonary edema was: 3 (Grade 1), 4 (Grade 2-4), 3 (Grade 5). Pulmonary edema developed in 33% of patients with continuous magnesium infusion (vs. 26% of those without magnesium).
CONCLUSIONS: Patients with SAH had evidence of frequent cardiovascular morbidity with more than 50% of patients having ST and T wave abnormalities. Bradycardia was noted in 36% of patients. The development of pulmonary edema was not related to the H&H grade of SAH. Patients receiving continuous magnesium sulfate infusion did not develop pulmonary edema more frequently than those who did not receive this therapy to prevent vasospasm (Fischer’s exact test p=.07)
CLINICAL IMPLICATIONS: Cardiovascular morbidity is common in SAH. Pulmonary edema may occur with normal troponin and ECHOcardiogram
DISCLOSURE: The following authors have nothing to disclose: Karim Yacoub, Kristin Fless, Paul Yodice, Fariborz Rezai, Mikhail Litinski
No Product/Research Disclosure InformationSaint Barnabas Medical Center, Livingston, NJ