The changes of ECG in patients with acute cerebral stroke

The significance in clinical practice
Protect myocardium during earlier period We’d better select frusemin instead of manicol once the changes of ECG are severe and persistent
Relevant factors
The size of the lesion Larger is the lesion ,higher is the incidence the lesions are too small to inlfluent the incidence
Relevant factors

Probable mechanism
Electrolyte disturbance often occurs after stroke as a result of vomiting, fever, malnutrition, venous inflow
Probable mechanism
The side-effect of therapeutic medication , for example hemodynamics factors as a result of manicol
elevation CK CK-MB 6h <6h peak 24h <18h comeback 3-4d 2-3d
LDH
cTNI
8-10h
4-6
48-72h
/
gnosis
The alteration of T-wave ,elevation of CK and TNI are reversible according to therapy The changes of ECG are consistent with condition of the patients

The incidence of abnormal ECG and the relevant factors Probable mechanism The manifestation of abnormal ECG Differential diagnosis The significance in clinical practice

Probable mechanism
The patients usually have concomitant disease: arteriosclerosis , hyperlipemia, hypertention etc. The burden of the heart increase significantly after stroke
flattening or inversion, ST-segment alterations, prolonged Q-T interval, prominent

U waves All kinds of arrhythmia :tachycardia, bradycardia, premature beat,fibrillation Cardiac conduction block: atrioventricular block ,right bundle branch block Acute myocardial infarction or acute endocardium infarction:the changes of ST-T,abnormal Q-wave
The changes of ECG in patients with acute cerebral stroke
Li Xinyu
The electrocardiogram changes and cardiac arrhythmias frequently encountered after stroke are not solely explicable by concomitant ischemic cardiac disease.
Probable mechanism
There are definite nerve conduction pathways and definite transmitters between the brain and the heart Experimental and clinical evidence now implicates the insular cortex and its subcortical connections in the generation of cardiac arrhythmias under stress and following hemispheric stroke.

The significance in clinical practice
Cerebral arrhythmogenesis may underlie sudden death and the changes of ECG after cerebral stroke relate to the mortality It is useful to evaluate the prognosis
Relevant factors
The age of the patients Older are the patients ,higher is the incidence
The manifestation of the abnormal ECG

The insufficiency of coronary arterial perfusion : the changes of ST-T,such as T-wave

Differential diagnosis

Sometimes consultation of cardiologist is necessary
The significance in clinical practice
Cardiac monitoring is essential in order to detect the damage of myocardium in time It is very important to control intracranial pressure effectively to lessen the impairment of midline structure
Differential diagnosis
Creatine kinase (CK) elevates irregularly The rise of Troponin I (TNI) is more specific to the damage of myocardium

The changes of myocardial enzymes in AMI

The location of the lesions Thalamus and brain stem Subarachnoid The region of basal ganglia Lobe of the brain
Relevant factors
The level of consciousness Disturbance of consciousness wakefulness
Differential diagnosis from myocardial infarction

Characteristics of ECG : ST segment alteration dominates, the abnormalitis usually involve multiple leads which are not localizable

Insular cortex
hypothalamus
Brain stem
the heart
Spinal cord
Probable mechanism
Augmentation of intracardiac sympathetic nerve activity occurs may be crucial for the generation of cardiac arrhythmias Arrhythmias could be seen after stroke of either hemisphere and would be more common after cerebral infarction on the right autonomic

The incidence of abnormal ECG after acute cerebral stroke is about 50%~90%
Relevant factors
Abnormal ECG presents more often after hemorrhagic stroke than after ischemic stroke Subarachnoid hemorrhage Cerebral hemorrhage Cerebral infarction
Since Cerebral-cardiac syndrome was first reported by Byer in1947,the changes of ECG in patients with acute cerebral stroke are attracting more attention.
As clinicians of neurology,we are often puzzled by the changes of ECG in patients with acute cerebral stroke It is difficult to distinguish myocardial ischemia or infarction from neurogenic cardiac effects of cerebrovascular disease.