Indian Journal of Neurotrauma 2016; 13(02): 070-074
DOI: 10.1055/s-0036-1586237
Original Article
Thieme Medical and Scientific Publishers Private Ltd.

Electrocardiographic Changes in Patients with Isolated Traumatic Brain Injury and Their Correlation with Outcome

Veda Dhruthy Samudrala
1   Department of Neurosurgery, Narayana Medical College & Hospital, Chinthareddypalem, Nellore, Andhra Pradesh, India
,
Ashutosh Kumar
2   Department of Cardiology, Narayana Medical College & Hospital, Chinthareddypalem, Nellore, Andhra Pradesh, India
,
Amit Agrawal
1   Department of Neurosurgery, Narayana Medical College & Hospital, Chinthareddypalem, Nellore, Andhra Pradesh, India
› Author Affiliations
Further Information

Publication History

12 August 2015

23 June 2016

Publication Date:
10 August 2016 (online)

Abstract

Objectives Electrocardiography (ECG) can be used as an inexpensive tool to identify high-risk patients who are at risk of developing cardiac dysfunction following traumatic brain injury (TBI). In the present article, we report our experience with the incidence of electrocardiographic changes in patients with TBI patients and their correlation with overall outcome.

Materials and Methods All the patients who were admitted with the diagnosis of TBI under neurosurgery were included in the study. Clinical details and 12 lead ECG details for any ECG abnormalities (rhythm abnormalities, conduction abnormalities, QRS ST complex abnormalities, nonspecific ST changes, QT interval abnormalities, and data regarding outcome) were recorded. The data were entered into a spreadsheet and analyzed using StatsDirect version 3 statistical analysis software. Data were expressed using descriptive statistics—frequency and percentage for categorical variables. Pearson chi-square test was used to identify significance. p < 0.05 was considered significant.

Results A total of 109 patients and same number of admission ECGs were available for interpretation. Mild head injury was most common (65.1%) followed by severe (18.3%) and moderate (15.6%) head injuries. ECG results were normal in 97 patients and were abnormal in 12 patients. Statistical analysis showed that the correlation among severity of the head injury, ECG results, and outcome was significant. However, there was no significant correlation between QTc and outcome, and correlation between severity of head injury and outcome.

Conclusion The present study highlights the need to recognize the importance of ECG as a simple tool to identify the cardiovascular changes in patients with TBI. However, there is a need to conduct further prospective studies to supplement these findings with changes in the levels of cardiac enzymes or associated echocardiography abnormalities and their correlation with ECG findings and overall outcome.

 
  • References

  • 1 Rutland-Brown W, Langlois JA, Thomas KE, Xi YL. Incidence of traumatic brain injury in the United States, 2003. J Head Trauma Rehabil 2006; 21 (6) 544-548
  • 2 Sosin DM, Sniezek JE, Waxweiler RJ. Trends in death associated with traumatic brain injury, 1979 through 1992. Success and failure. JAMA 1995; 273 (22) 1778-1780
  • 3 Agrawal A, Coronado VG, Bell JM , et al. Characteristics of patients who died from traumatic brain injury in two rural hospital emergency departments in Maharashtra, India, 2007-2009. Int J Crit Illn Inj Sci 2014; 4 (4) 293-297
  • 4 Agrawal A, Galwankar S, Kapil V , et al. Epidemiology and clinical characteristics of traumatic brain injuries in a rural setting in Maharashtra, India. 2007-2009. Int J Crit Illn Inj Sci 2012; 2 (3) 167-171
  • 5 Calvo-Romero JM, Fernández De Soria-Pantoja R, Arrebola-García JD, Gil-Cubero M. [Electrocardiographic abnormalities in subarachnoid hemorrhage]. Rev Neurol 2001; 32 (6) 536-537
  • 6 Hirashima Y, Takashima S, Matsumura N, Kurimoto M, Origasa H, Endo S. Right sylvian fissure subarachnoid hemorrhage has electrocardiographic consequences. Stroke 2001; 32 (10) 2278-2281
  • 7 Gregory T, Smith M. Cardiovascular complications of brain injury. Contin Educ Anaesth Crit Care Pain 2012; 12: 67-71
  • 8 van der Bilt IAC, Hasan D, Vandertop WP , et al. Impact of cardiac complications on outcome after aneurysmal subarachnoid hemorrhage: a meta-analysis. Neurology 2009; 72 (7) 635-642
  • 9 Zygun D. Non-neurological organ dysfunction in neurocritical care: impact on outcome and etiological considerations. Curr Opin Crit Care 2005; 11 (2) 139-143
  • 10 Schulte Esch J, Murday H, Pfeifer G. Haemodynamic changes in patients with severe head injury. Acta Neurochir (Wien) 1980; 54 (3–4) 243-250
  • 11 Dash M, Bithal PK, Prabhakar H, Chouhan RS, Mohanty B. ECG changes in pediatric patients with severe head injury. J Neurosurg Anesthesiol 2003; 15 (3) 270-273
  • 12 Bhagat H, Narang R, Sharma D, Dash HH, Chauhan H. ST elevation—an indication of reversible neurogenic myocardial dysfunction in patients with head injury. Ann Card Anaesth 2009; 12 (2) 149-151
  • 13 Hüttemann E, Schelenz C, Chatzinikolaou K, Reinhart K. Left ventricular dysfunction in lethal severe brain injury: impact of transesophageal echocardiography on patient management. Intensive Care Med 2002; 28 (8) 1084-1088
  • 14 Agrawal A, Reddy GV. Cardiovascular abnormalities in patients with traumatic brain injury. Cardiology Today 2014; XVIII: 14-16
  • 15 Krishnamoorthy V, Prathep S, Sharma D, Gibbons E, Vavilala MS. Association between electrocardiographic findings and cardiac dysfunction in adult isolated traumatic brain injury. Indian J Crit Care Med 2014; 18 (9) 570-574
  • 16 Shanlin RJ, Sole MJ, Rahimifar M, Tator CH, Factor SM. Increased intracranial pressure elicits hypertension, increased sympathetic activity, electrocardiographic abnormalities and myocardial damage in rats. J Am Coll Cardiol 1988; 12 (3) 727-736
  • 17 Shivalkar B, Van Loon J, Wieland W , et al. Variable effects of explosive or gradual increase of intracranial pressure on myocardial structure and function. Circulation 1993; 87 (1) 230-239
  • 18 Schrader H, Hall C, Zwetnow NN. Effects of prolonged supratentorial mass expansion on regional blood flow and cardiovascular parameters during the Cushing response. Acta Neurol Scand 1985; 72 (3) 283-294
  • 19 Di Angelantonio E, Fiorelli M, Toni D , et al. Prognostic significance of admission levels of troponin I in patients with acute ischaemic stroke. J Neurol Neurosurg Psychiatry 2005; 76 (1) 76-81
  • 20 James P, Ellis CJ, Whitlock RM, McNeil AR, Henley J, Anderson NE. Relation between troponin T concentration and mortality in patients presenting with an acute stroke: observational study. BMJ 2000; 320 (7248) 1502-1504
  • 21 Song H-S, Back J-H, Jin D-K , et al. Cardiac troponin T elevation after stroke: relationships between elevated serum troponin T, stroke location, and prognosis. J Clin Neurol 2008; 4 (2) 75-83
  • 22 Kolin A, Norris JW. Myocardial damage from acute cerebral lesions. Stroke 1984; 15 (6) 990-993
  • 23 Myers MG, Norris JW, Hachinski VC, Weingert ME, Sole MJ. Cardiac sequelae of acute stroke. Stroke 1982; 13 (6) 838-842
  • 24 Parr MJ, Finfer SR, Morgan MK. Reversible cardiogenic shock complicating subarachnoid haemorrhage. BMJ 1996; 313 (7058) 681-683
  • 25 Dupuis M, van Rijckevorsel K, Evrard F, Dubuisson N, Dupuis F, Van Robays P. Takotsubo syndrome (TKS): a possible mechanism of sudden unexplained death in epilepsy (SUDEP). Seizure 2012; 21 (1) 51-54
  • 26 Wittstein IS, Thiemann DR, Lima JAC , et al. Neurohumoral features of myocardial stunning due to sudden emotional stress. N Engl J Med 2005; 352 (6) 539-548
  • 27 Prathep S, Sharma D, Hallman M , et al. Preliminary report on cardiac dysfunction after isolated traumatic brain injury. Crit Care Med 2014; 42 (1) 142-147
  • 28 Frangiskakis JM, Hravnak M, Crago EA , et al. Ventricular arrhythmia risk after subarachnoid hemorrhage. Neurocrit Care 2009; 10 (3) 287-294
  • 29 Lim HB, Smith M. Systemic complications after head injury: a clinical review. Anaesthesia 2007; 62 (5) 474-482
  • 30 Nguyen H, Zaroff JG. Neurogenic stunned myocardium. Curr Neurol Neurosci Rep 2009; 9 (6) 486-491
  • 31 Tung P, Kopelnik A, Banki N , et al. Predictors of neurocardiogenic injury after subarachnoid hemorrhage. Stroke 2004; 35 (2) 548-551
  • 32 Nguyen M-D, Giridharan G, Prabhu SD, Sethu P. Microfluidic cardiac circulation model (microCCM) for functional cardiomyocyte studies. Conference proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual Conference; 2009: 1060-1063
  • 33 Macmillan CSA, Grant IS, Andrews PJD. Pulmonary and cardiac sequelae of subarachnoid haemorrhage: time for active management?. Intensive Care Med 2002; 28 (8) 1012-1023
  • 34 Chang PC, Lee SH, Hung HF, Kaun P, Cheng JJ. Transient ST elevation and left ventricular asynergy associated with normal coronary artery and Tc-99m PYP myocardial infarct scan in subarachnoid hemorrhage. Int J Cardiol 1998; 63 (2) 189-192
  • 35 Jachuck SJ, Ramani PS, Clark F, Kalbag RM. Electrocardiographic abnormalities associated with raised intracranial pressure. BMJ 1975; 1 (5952) 242-244
  • 36 Collier BR, Miller SL, Kramer GS, Balon JA, Gonzalez III LS. Traumatic subarachnoid hemorrhage and QTc prolongation. J Neurosurg Anesthesiol 2004; 16 (3) 196-200
  • 37 Kono T, Morita H, Kuroiwa T, Onaka H, Takatsuka H, Fujiwara A. Left ventricular wall motion abnormalities in patients with subarachnoid hemorrhage: neurogenic stunned myocardium. J Am Coll Cardiol 1994; 24 (3) 636-640
  • 38 Fan X, Du FH, Tian JP. The electrocardiographic changes in acute brain injury patients. Chin Med J (Engl) 2012; 125 (19) 3430-3433
  • 39 Hersch C. Electrocardiographic changes in head injuries. Circulation 1961; 23: 853-860