Study of electrocardiographic changes in acute cerebrovascular accidents in elderly patients in a tertiary care hospital

 

Mohammed Ubaidulla Mohammed Ataulla¹, Prashant SudamDhumal², D P Bhurke^3*

 

¹Associate Professor, ²PG Student, ³Professor and HOD, Department of Medicine Dr. Shankarrao Chavan Government Medical College, Nanded, Maharashtra, INDIA.

Email: dr.prashantdhumal92@gmail.com

 

Abstract              Background: Stroke is an important contributor to morbidity, mortality and disability across the globe. The prevalence of stroke appears to be comparatively less in India but it is likely to increase. The proportion of stroke in the young population is significantly more in India than in developed countries. Cardiovascular effects of strokes are often modulated by concomitant or pre-existent cardiac diseases, and are also related to the type of cerebrovascular disease and its localization. Objectives: To study the electrocardiographic changes observed in different types of cerebrovascular accident and the prevalence of ECG changes in different types of cerebrovascular accident and to establish the prognostic significance. Materials and Methods: This study was the prospective study of 100 subjects with the diagnosis of cerebrovascular accidents. The subjects who had no evidence of prior cardiac abnormalities, no prior history of stroke or reasons for electrolyte effect abnormalities on their electrocardiograms were included. Investigations: Complete blood picture, ECG, Serum electrolytesetc. Results: The cerebrovascular accidents increases with age with 25% in the age group of <60 yrs and 45% above 70yrs. Cerebral thrombosis formed the largest group in the study comprising 54% of cases. Fifty four patients were known hypertensive. It is seen that in the 100 cases studies 81 cases had some abnormality in the ECG which was more common in patients of cerebral haemorrhage. The most common ECG abnormality associated with stroke was T wave changes (44%).T wave changes were more frequent in cerebral haemorrhage. Q-Tc prolongation occurred more frequently in patients with cerebral hemorrhage. ST segment changes were more frequent in cerebral hemorrhage. Overall immediate mortality was higher in cerebral hemorrhage (51.6%).The highest mortality was seen in comatose patients (50%). Conclusion: The ECG changes were common in hemorrhage than in infarcts. These changes were presumed to be due to alterations in sympathetic andparasympathetic tone. The mortality in these patients did not relate to the ECG changes seen but was dependent on the type of CVA and the level of consciousness on admission. Atrial fibrillation was more frequent in ischemic stroke than in hemorrhagic stroke. ST depression and Q waves, suggesting that these ECG changes may indicate coexisting ischaemic heart disease.

Key Words: acute cerebrovascular accidents.