Use of the peak troponin value to differentiate myocardial infarction from reversible neurogenic left ventricular dysfunction associated with aneurysmal subarachnoid hemorrhage

View More View Less
  • 1 Departments of Surgery (Neurosurgery), Medicine (Cardiology), and Anesthesiology, Duke University Medical Center, Durham, North Carolina
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
Print or Print + Online

Object. Differentiating myocardial infarction (MI) from reversible neurogenic left ventricular dysfunction (stunned myocardium [SM]) associated with aneurysmal subarachnoid hemorrhage (SAH) is critical for early surgical intervention. The authors hypothesized that the cardiac troponin (cTn) trend and/or echocardiogram could be used to differentiate between the two entities.

Methods. A retrospective study was conducted for the period between 1995 and 2000. All patients included in the study met the following criteria: 1) no history of cardiac problems; 2) new onset of abnormal cardiac function (ejection fraction [EF] < 40% on echocardiograms); 3) serial cardiac markers (cTn and creatine kinase MB isoform [CK-MB]); 4) surgical intervention for their aneurysm; and 5) cardiac output monitoring either by repeated echocardiograms or invasive hemodynamic monitoring during the first 4 days post-SAH when the patients were euvolemic.

Of the 350 patients with SAH, 10 (2.9%) had severe cardiac dysfunction. Of those 10, six were women and four were men. The patients' mean age was 53.5 years (range 29–75 years) and their SAH was classified as Hunt and Hess Grade III or IV. Aneurysm distribution was as follows: basilar artery tip (four); anterior communicating artery (two); middle cerebral artery (one); posterior communicating artery (two); and posterior inferior cerebellar artery (one). The mean EF at onset was 33%. The changes on echocardiograms in these patients did not match the findings on electrocardiograms (EKGs). Within 4.5 days, dramatic improvement was seen in cardiac output (from 4.93 ± 1.16 L/minute to 7.74 ± 0.88 L/minute). Compared with historical controls in whom there were similar levels of left ventricular dysfunction after MI, there was no difference in peak CK-MB. A 10-fold difference, however, was noted in cTn values (0.22 ± 0.25 ng/ml; control 2.8 ng/ml; p < 0.001).

Conclusions. The authors determined the following: 1) that the CK-MB trend does not allow differentiation between SM and MI; 2) that echocardiograms revealing significant inconsistencies with EKGs are indicative of SM; and 3) that cTn values less than 2.8 ng/ml in patients with EFs less than 40% are consistent with SM.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
  • 1.

    Adams JE III, , Bodor GS, & Davila-Roman VG, et al: Cardiac troponin I. A marker with high specificity for cardiac injury. Circulation 88:101106, 1993 Adams JE III, Bodor GS, Davila-Roman VG, et al: Cardiac troponin I. A marker with high specificity for cardiac injury. Circulation 88:101–106, 1993

    • Search Google Scholar
    • Export Citation
  • 2.

    Aschenbrenner R, & Bodechtel G: Über EKG-Veranderungen bei Hirntumorkranken. Klin Wochenschr 17:298302, 1938 Aschenbrenner R, Bodechtel G: Über EKG-Veranderungen bei Hirntumorkranken. Klin Wochenschr 17:298–302, 1938

    • Search Google Scholar
    • Export Citation
  • 3.

    Attar HJ, , Gutierrez MT, & Bellet S, et al: Effects of stimulation of hypothalamus and reticular activating system on production of cardiac arrythmias. Circ Res 12:1421, 1963 Attar HJ, Gutierrez MT, Bellet S, et al: Effects of stimulation of hypothalamus and reticular activating system on production of cardiac arrythmias. Circ Res 12:14–21, 1963

    • Search Google Scholar
    • Export Citation
  • 4.

    Ay H, , Arsava EM, & Saribas O: Creatine kinase-MB elevation after stroke is not cardiac in origin: comparison with troponin T levels. Stroke 33:286289, 2002 Ay H, Arsava EM, Saribas O: Creatine kinase-MB elevation after stroke is not cardiac in origin: comparison with troponin T levels. Stroke 33:286–289, 2002

    • Search Google Scholar
    • Export Citation
  • 5.

    Bayley RH: The electrocardiographic effects of injury at the endocardial surface of the left ventricle. Am Heart J 31:677684, 1946 Bayley RH: The electrocardiographic effects of injury at the endocardial surface of the left ventricle. Am Heart J 31:677–684, 1946

    • Search Google Scholar
    • Export Citation
  • 6.

    Bhagat CI, , Langton P, & Lewer M, et al: Cardiac troponin I should replace CKMB for the diagnosis of acute myocardial infarction. Ann Clin Biochem 34:511516, 1997 Bhagat CI, Langton P, Lewer M, et al: Cardiac troponin I should replace CKMB for the diagnosis of acute myocardial infarction. Ann Clin Biochem 34:511–516, 1997

    • Search Google Scholar
    • Export Citation
  • 7.

    Boddin M, , Van Bogaert A, & Dierick W: Catecholemines in blood myocardial tissue in experimental subarachnoid hemorrhage. Cardiology 58:229237, 1973 Boddin M, Van Bogaert A, Dierick W: Catecholemines in blood myocardial tissue in experimental subarachnoid hemorrhage. Cardiology 58:229–237, 1973

    • Search Google Scholar
    • Export Citation
  • 8.

    Brouwers PJ, , Wijdicks EF, & Hasan D, et al: Serial electrocardiographic recording in aneurysmal subarachnoid hemorrhage. Stroke 20:11621167, 1989 Brouwers PJ, Wijdicks EF, Hasan D, et al: Serial electrocardiographic recording in aneurysmal subarachnoid hemorrhage. Stroke 20:1162–1167, 1989

    • Search Google Scholar
    • Export Citation
  • 9.

    Burch GE, , Meyers R, & Abildskov JA: A new electrocardiogram pattern observed in cerebrovascular accidents. Circulation 9:719723, 1954 Burch GE, Meyers R, Abildskov JA: A new electrocardiogram pattern observed in cerebrovascular accidents. Circulation 9:719–723, 1954

    • Search Google Scholar
    • Export Citation
  • 10.

    Ceconi C, , Curello S, & Ferrari R: Catecholamines: the cardiovascular and neuroendocrine system. Eur Heart J 19 (Suppl F):F2F6, 1998 Ceconi C, Curello S, Ferrari R: Catecholamines: the cardiovascular and neuroendocrine system. Eur Heart J 19 (Suppl F):F2–F6, 1998

    • Search Google Scholar
    • Export Citation
  • 11.

    Collinson PO: Troponin T or troponin I or CK-MB (or none?). Eur Heart J 19 (Suppl N):N16N24, 1998 Collinson PO: Troponin T or troponin I or CK-MB (or none?). Eur Heart J 19 (Suppl N):N16–N24, 1998

    • Search Google Scholar
    • Export Citation
  • 12.

    Collinson PO, , Moseley D, & Stubbs PJ, et al: Troponin T for the differential diagnosis of ischaemic myocardial damage. Ann Clin Biochem 30:1116, 1993 Collinson PO, Moseley D, Stubbs PJ, et al: Troponin T for the differential diagnosis of ischaemic myocardial damage. Ann Clin Biochem 30:11–16, 1993

    • Search Google Scholar
    • Export Citation
  • 13.

    Connor RC: Heart damage associated with intracranial lesions. Br Med J 3:2931, 1968 Connor RC: Heart damage associated with intracranial lesions. Br Med J 3:29–31, 1968

    • Search Google Scholar
    • Export Citation
  • 14.

    Cooperman M, , Pflug B, & Martin EW Jr, et al: Cardiovascular risk factors in patients with peripheral vascular disease. Surgery 84:505509, 1978 Cooperman M, Pflug B, Martin EW Jr, et al: Cardiovascular risk factors in patients with peripheral vascular disease. Surgery 84:505–509, 1978

    • Search Google Scholar
    • Export Citation
  • 15.

    Cruickshank JM, , Neil-Dwyer G, & Lane J: The effect of oral propranolol upon the ECG changes occurring in subarachnoid haemorrhage. Cardiovasc Res 9:236245, 1975 Cruickshank JM, Neil-Dwyer G, Lane J: The effect of oral propranolol upon the ECG changes occurring in subarachnoid haemorrhage. Cardiovasc Res 9:236–245, 1975

    • Search Google Scholar
    • Export Citation
  • 16.

    Davies KR, , Gelb AW, & Manninen PH, et al: Cardiac function in aneurysmal subarachnoid haemorrhage: a study of electrocardiographic and echocardiographic abnormalities. Br J Anaesth 67:5863, 1991 Davies KR, Gelb AW, Manninen PH, et al: Cardiac function in aneurysmal subarachnoid haemorrhage: a study of electrocardiographic and echocardiographic abnormalities. Br J Anaesth 67:58–63, 1991

    • Search Google Scholar
    • Export Citation
  • 17.

    Di Pasquale G, , Andreoli A, & Lusa AM, et al: Cardiologic complications of subarachnoid hemorrhage. J Neurosurg Sci 42 (Suppl 1):3336, 1998 Di Pasquale G, Andreoli A, Lusa AM, et al: Cardiologic complications of subarachnoid hemorrhage. J Neurosurg Sci 42 (Suppl 1):33–36, 1998

    • Search Google Scholar
    • Export Citation
  • 18.

    Di Pasquale G, , Pinelli G, & Andreoli A, et al: Holter detection of cardiac arrhythmias in intracranial subarachnoid hemorrhage. Am J Cardiol 59:596600, 1987 Di Pasquale G, Pinelli G, Andreoli A, et al: Holter detection of cardiac arrhythmias in intracranial subarachnoid hemorrhage. Am J Cardiol 59:596–600, 1987

    • Search Google Scholar
    • Export Citation
  • 19.

    Donaldson JW, & Pritz MB: Myocardial stunning secondary to aneurysmal subarachnoid hemorrhage. Surg Neurol 55:1216, 2001 Donaldson JW, Pritz MB: Myocardial stunning secondary to aneurysmal subarachnoid hemorrhage. Surg Neurol 55:12–16, 2001

    • Search Google Scholar
    • Export Citation
  • 20.

    Doshi R, & Neil-Dwyer G: A clinicopathological study of patients following a subarachnoid hemorrhage. J Neurosurg 52:295301, 1980 Doshi R, Neil-Dwyer G: A clinicopathological study of patients following a subarachnoid hemorrhage. J Neurosurg 52:295–301, 1980

    • Search Google Scholar
    • Export Citation
  • 21.

    Estanol BV, & Marin OS: Cardiac arrhythmias and sudden death in subarachnoid hemorrhage. Stroke 6:382386, 1975 Estanol BV, Marin OS: Cardiac arrhythmias and sudden death in subarachnoid hemorrhage. Stroke 6:382–386, 1975

    • Search Google Scholar
    • Export Citation
  • 22.

    Fabinyi G, , Hunt D, & McKinley L: Myocardial creatine kinase isoenzyme in serum after subarachnoid haemorrhage. J Neurol Neurosurg Psychiatry 40:818820, 1977 Fabinyi G, Hunt D, McKinley L: Myocardial creatine kinase isoenzyme in serum after subarachnoid haemorrhage. J Neurol Neurosurg Psychiatry 40:818–820, 1977

    • Search Google Scholar
    • Export Citation
  • 23.

    Fentz V: Electrocardiographic patterns in patients with cerebrovascular accidents. Circulation 25:2228, 1962 Fentz V: Electrocardiographic patterns in patients with cerebrovascular accidents. Circulation 25:22–28, 1962

    • Search Google Scholar
    • Export Citation
  • 24.

    Gascon P, , Ley TJ, & Toltzis RJ, et al: Spontaneous subarachnoid hemorrhage simulating acute transmural myocardial infarction. Am Heart J 105:511513, 1983 Gascon P, Ley TJ, Toltzis RJ, et al: Spontaneous subarachnoid hemorrhage simulating acute transmural myocardial infarction. Am Heart J 105:511–513, 1983

    • Search Google Scholar
    • Export Citation
  • 25.

    Goldfein A, & Ganong WF: Adrenal medullary and adrenal cortical response to stimulation of the diencephalon. Am J Physiol 202:205211, 1962 Goldfein A, Ganong WF: Adrenal medullary and adrenal cortical response to stimulation of the diencephalon. Am J Physiol 202:205–211, 1962

    • Search Google Scholar
    • Export Citation
  • 26.

    Goldman L, , Caldera DL, & Nussbaum SR, et al: Multifactorial index of cardiac risk in noncardiac surgical procedures. N Engl J Med 297:845850, 1977 Goldman L, Caldera DL, Nussbaum SR, et al: Multifactorial index of cardiac risk in noncardiac surgical procedures. N Engl J Med 297:845–850, 1977

    • Search Google Scholar
    • Export Citation
  • 27.

    Greenhoot JH, & Reichenbach DD: Cardiac injury and subarachnoid hemorrhage. A clinical, pathological, and physiological correlation. J Neurosurg 30:521531, 1969 Greenhoot JH, Reichenbach DD: Cardiac injury and subarachnoid hemorrhage. A clinical, pathological, and physiological correlation. J Neurosurg 30:521–531, 1969

    • Search Google Scholar
    • Export Citation
  • 28.

    Harries AD: Subarachnoid haemorrhage and the electrocardiogram—a review. Postgrad Med J 57:294296, 1981 Harries AD: Subarachnoid haemorrhage and the electrocardiogram—a review. Postgrad Med J 57:294–296, 1981

    • Search Google Scholar
    • Export Citation
  • 29.

    Heinrich D, & Muller W: Focal myocardial necrosis in cases of increased intracranial pressure. Eur Neurol 12:369376, 1974 Heinrich D, Muller W: Focal myocardial necrosis in cases of increased intracranial pressure. Eur Neurol 12:369–376, 1974

    • Search Google Scholar
    • Export Citation
  • 30.

    Hop JW, , Rinkel GJ, & Algra A, et al: Case-fatality rates and functional outcome after subarachnoid hemorrhage: a systematic review. Stroke 28:660664, 1997 Hop JW, Rinkel GJ, Algra A, et al: Case-fatality rates and functional outcome after subarachnoid hemorrhage: a systematic review. Stroke 28:660–664, 1997

    • Search Google Scholar
    • Export Citation
  • 31.

    Horowitz MB, , Willet D, & Keffer J: The use of cardiac troponin-I (cTnI) to determine the incidence of myocardial ischemia and injury in patients with aneurysmal and presumed aneurysmal subarachnoid hemorrhage. Acta Neurochir 140:8793, 1998 Horowitz MB, Willet D, Keffer J: The use of cardiac troponin-I (cTnI) to determine the incidence of myocardial ischemia and injury in patients with aneurysmal and presumed aneurysmal subarachnoid hemorrhage. Acta Neurochir 140:87–93, 1998

    • Search Google Scholar
    • Export Citation
  • 32.

    Hunt D, , McRae C, & Zapf P: Electrocardiographic and serum enzyme change in subarachnoid hemorrhage. Am Heart J 77:479488, 1969 Hunt D, McRae C, Zapf P: Electrocardiographic and serum enzyme change in subarachnoid hemorrhage. Am Heart J 77:479–488, 1969

    • Search Google Scholar
    • Export Citation
  • 33.

    Hunt WE, & Hess RM: Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg 28:1420, 1968 Hunt WE, Hess RM: Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg 28:14–20, 1968

    • Search Google Scholar
    • Export Citation
  • 34.

    Jacob WA, , Van Bogaert A, & De Groodt-Lasseel MH: Myocardial ultrastructure and haemodynamic reactions during experimental subarachnoid haemorrhage. J Mol Cell Cardiol 4:287298, 1972 Jacob WA, Van Bogaert A, De Groodt-Lasseel MH: Myocardial ultrastructure and haemodynamic reactions during experimental subarachnoid haemorrhage. J Mol Cell Cardiol 4:287–298, 1972

    • Search Google Scholar
    • Export Citation
  • 35.

    Klouda MA, & Brynjolfsson G: Cardiotoxic effects of electrical stimulation of the stellate ganglion. Ann NY Acad Sci 156:271280, 1969 Klouda MA, Brynjolfsson G: Cardiotoxic effects of electrical stimulation of the stellate ganglion. Ann NY Acad Sci 156:271–280, 1969

    • Search Google Scholar
    • Export Citation
  • 36.

    Kolin A, & Norris JW: Myocardial damage from acute cerebral lesions. Stroke 15:990993, 1984 Kolin A, Norris JW: Myocardial damage from acute cerebral lesions. Stroke 15:990–993, 1984

    • Search Google Scholar
    • Export Citation
  • 37.

    Korteweg GCJ, , Boeles JTF, & ten Cate J: Influence of stimulation of some subcortical areas on electrocardiogram. J Neurophysiol 20:100107, 1957 Korteweg GCJ, Boeles JTF, ten Cate J: Influence of stimulation of some subcortical areas on electrocardiogram. J Neurophysiol 20:100–107, 1957

    • Search Google Scholar
    • Export Citation
  • 38.

    Koskelo P, , Punsar S, & Sipilä W: Subendocardial haemorrhage and E.C.G. changes in intracranial bleeding. Br Med J 1:14791480, 1964 Koskelo P, Punsar S, Sipilä W: Subendocardial haemorrhage and E.C.G. changes in intracranial bleeding. Br Med J 1:1479–1480, 1964

    • Search Google Scholar
    • Export Citation
  • 39.

    Kreus KE, , Kemila SJ, & Takala JK: Electrocardiographic changes in cerebrovascular accidents. Acta Med Scand 185:327334, 1969 Kreus KE, Kemila SJ, Takala JK: Electrocardiographic changes in cerebrovascular accidents. Acta Med Scand 185:327–334, 1969

    • Search Google Scholar
    • Export Citation
  • 40.

    Kuroiwa T, , Morita H, & Tanabe H, et al: Significance of ST segment elevation in electrocardiograms in patients with ruptured cerebral aneurysms. Acta Neurochir 133:141146, 1995 Kuroiwa T, Morita H, Tanabe H, et al: Significance of ST segment elevation in electrocardiograms in patients with ruptured cerebral aneurysms. Acta Neurochir 133:141–146, 1995

    • Search Google Scholar
    • Export Citation
  • 41.

    Lanzino G, , Kongable GL, & Kassell NF: Electrocardiographic abnormalities after nontraumatic subarachnoid hemorrhage. J Neurosurg Anesthesiol 6:156162, 1994 Lanzino G, Kongable GL, Kassell NF: Electrocardiographic abnormalities after nontraumatic subarachnoid hemorrhage. J Neurosurg Anesthesiol 6:156–162, 1994

    • Search Google Scholar
    • Export Citation
  • 42.

    Mann DL, , Kent RL, & Parsons B, et al: Adrenergic effects on the biology of the adult mammalian cardiocyte. Circulation 85:790804, 1992 Mann DL, Kent RL, Parsons B, et al: Adrenergic effects on the biology of the adult mammalian cardiocyte. Circulation 85:790–804, 1992

    • Search Google Scholar
    • Export Citation
  • 43.

    Marin MM, & Teichman SL: Use of rapid serial sampling of creatine kinase MB for very early detection of myocardial infarction in patients with acute chest pain. Am Heart J 123:354361, 1992 Marin MM, Teichman SL: Use of rapid serial sampling of creatine kinase MB for very early detection of myocardial infarction in patients with acute chest pain. Am Heart J 123:354–361, 1992

    • Search Google Scholar
    • Export Citation
  • 44.

    Marion DW, , Segal R, & Thompson ME: Subarachnoid hemorrhage and the heart. Neurosurgery 18:101106, 1986 Marion DW, Segal R, Thompson ME: Subarachnoid hemorrhage and the heart. Neurosurgery 18:101–106, 1986

    • Search Google Scholar
    • Export Citation
  • 45.

    Mayer SA, , LiMandri G, & Sherman D, et al: Electrocardiographic markers of abnormal left ventricular wall motion in acute subarachnoid hemorrhage. J Neurosurg 83:889896, 1995 Mayer SA, LiMandri G, Sherman D, et al: Electrocardiographic markers of abnormal left ventricular wall motion in acute subarachnoid hemorrhage. J Neurosurg 83:889–896, 1995

    • Search Google Scholar
    • Export Citation
  • 46.

    Mayer SA, , Lin J, & Homma S, et al: Myocardial injury and left ventricular performance after subarachnoid hemorrhage. Stroke 30:780786, 1999 Mayer SA, Lin J, Homma S, et al: Myocardial injury and left ventricular performance after subarachnoid hemorrhage. Stroke 30:780–786, 1999

    • Search Google Scholar
    • Export Citation
  • 47.

    Mayer SA, , Sherman D, & Fink ME, et al: Noninvasive monitoring of cardiac output by Doppler echocardiography in patients treated with volume expansion after subarachnoid hemorrhage. Crit Care Med 23:14701474, 1995 Mayer SA, Sherman D, Fink ME, et al: Noninvasive monitoring of cardiac output by Doppler echocardiography in patients treated with volume expansion after subarachnoid hemorrhage. Crit Care Med 23:1470–1474, 1995

    • Search Google Scholar
    • Export Citation
  • 48.

    Melville KI, , Blum B, & Shister HE, et al: Cardiac ischemic changes and arrythmias induced by hypothalamic stimulation. Am J Cardiol 12:781791, 1963 Melville KI, Blum B, Shister HE, et al: Cardiac ischemic changes and arrythmias induced by hypothalamic stimulation. Am J Cardiol 12:781–791, 1963

    • Search Google Scholar
    • Export Citation
  • 49.

    Mertes PM, , Carteaux JP, & Jaboin Y, et al: Estimation of myocardial interstitial norepinephrine release after brain death using cardiac microdialysis. Transplantation 57:371377, 1994 Mertes PM, Carteaux JP, Jaboin Y, et al: Estimation of myocardial interstitial norepinephrine release after brain death using cardiac microdialysis. Transplantation 57:371–377, 1994

    • Search Google Scholar
    • Export Citation
  • 50.

    Offerhaus L, & van Gool J: Electrocardiographic changes and tissue catecholamines in experimental subarachnoid haemorrhage. Cardiovasc Res 3:433440, 1969 Offerhaus L, van Gool J: Electrocardiographic changes and tissue catecholamines in experimental subarachnoid haemorrhage. Cardiovasc Res 3:433–440, 1969

    • Search Google Scholar
    • Export Citation
  • 51.

    Parekh N, , Venkatesh B, & Cross D, et al: Cardiac troponin I predicts myocardial dysfunction in aneurysmal subarachnoid hemorrhage. J Am Coll Cardiol 36:13281335, 2000 Parekh N, Venkatesh B, Cross D, et al: Cardiac troponin I predicts myocardial dysfunction in aneurysmal subarachnoid hemorrhage. J Am Coll Cardiol 36:1328–1335, 2000

    • Search Google Scholar
    • Export Citation
  • 52.

    Pollick C, , Cujec B, & Parker S, et al: Left ventricular wall motion abnormalities in subarachnoid hemorrhage: an echocardiographic study. J Am Coll Cardiol 12:600605, 1988 Pollick C, Cujec B, Parker S, et al: Left ventricular wall motion abnormalities in subarachnoid hemorrhage: an echocardiographic study. J Am Coll Cardiol 12:600–605, 1988

    • Search Google Scholar
    • Export Citation
  • 53.

    Rao AC, , Collinson PO, & Canepa-Anson R, et al: Troponin T measurement after myocardial infarction can identify left ventricular ejection of less than 40%. Heart 80:223225, 1998 Rao AC, Collinson PO, Canepa-Anson R, et al: Troponin T measurement after myocardial infarction can identify left ventricular ejection of less than 40%. Heart 80:223–225, 1998

    • Search Google Scholar
    • Export Citation
  • 54.

    Raymer K, & Choi P: Concurrent subarachnoid haemorrhage and myocardial injury. Can J Anaesth 44:515519, 1997 Raymer K, Choi P: Concurrent subarachnoid haemorrhage and myocardial injury. Can J Anaesth 44:515–519, 1997

    • Search Google Scholar
    • Export Citation
  • 55.

    Rudehill A, , Gordon E, & Sundqvist K, et al: A study of ECG abnormalities and myocardial specific enzymes in patients with subarachnoid haemorrhage. Acta Anaesthesiol Scand 26:344350, 1982 Rudehill A, Gordon E, Sundqvist K, et al: A study of ECG abnormalities and myocardial specific enzymes in patients with subarachnoid haemorrhage. Acta Anaesthesiol Scand 26:344–350, 1982

    • Search Google Scholar
    • Export Citation
  • 56.

    Rudehill A, , Olsson GL, & Sundqvist K, et al: ECG abnormalities in patients with subarachnoid haemorrhage and intracranial tumors. J Neurol Neurosurg Psychiatry 50:13751381, 1987 Rudehill A, Olsson GL, Sundqvist K, et al: ECG abnormalities in patients with subarachnoid haemorrhage and intracranial tumors. J Neurol Neurosurg Psychiatry 50:1375–1381, 1987

    • Search Google Scholar
    • Export Citation
  • 57.

    Rudehill A, , Sundqvist K, & Sylven C: QT and QT-peak interval measurements. A methodological study in patients with subarachnoid haemorrhage compared to a reference group. Clin Physiol 6:2337, 1986 Rudehill A, Sundqvist K, Sylven C: QT and QT-peak interval measurements. A methodological study in patients with subarachnoid haemorrhage compared to a reference group. Clin Physiol 6:23–37, 1986

    • Search Google Scholar
    • Export Citation
  • 58.

    Sakka SG, , Huettemann E, & Reinhart K: Acute left ventricular dysfunction and subarachnoid hemorrhage. J Neurosurg Anesthesiol 11:209213, 1999 Sakka SG, Huettemann E, Reinhart K: Acute left ventricular dysfunction and subarachnoid hemorrhage. J Neurosurg Anesthesiol 11:209–213, 1999

    • Search Google Scholar
    • Export Citation
  • 59.

    Samra SK, & Kroll DA: Subarachnoid hemorrhage and intraoperative electrocardiographic changes simulating myocardial ischemia— anesthesiologist's dilemma. Anesth Analg 64:8689, 1985 Samra SK, Kroll DA: Subarachnoid hemorrhage and intraoperative electrocardiographic changes simulating myocardial ischemia— anesthesiologist's dilemma. Anesth Analg 64:86–89, 1985

    • Search Google Scholar
    • Export Citation
  • 60.

    Sato K, , Masuda T, & Izumi T: Subarachnoid hemorrhage and myocardial damage clinical and experimental studies. Jpn Heart J 40:683701, 1999 Sato K, Masuda T, Izumi T: Subarachnoid hemorrhage and myocardial damage clinical and experimental studies. Jpn Heart J 40:683–701, 1999

    • Search Google Scholar
    • Export Citation
  • 61.

    Szabo MD, , Crosby G, & Hurford WE, et al: Myocardial perfusion following acute subarachnoid hemorrhage in patients with an abnormal electrocardiogram. Anesth Analg 76:253258, 1993 Szabo MD, Crosby G, Hurford WE, et al: Myocardial perfusion following acute subarachnoid hemorrhage in patients with an abnormal electrocardiogram. Anesth Analg 76:253–258, 1993

    • Search Google Scholar
    • Export Citation
  • 62.

    Wagner I, , Mair J, & Fridrich L, et al: Cardiac troponin T release in acute myocardial infarction is associated with scintigraphic estimates of myocardial scar. Coron Artery Dis 4:537544, 1993 Wagner I, Mair J, Fridrich L, et al: Cardiac troponin T release in acute myocardial infarction is associated with scintigraphic estimates of myocardial scar. Coron Artery Dis 4:537–544, 1993

    • Search Google Scholar
    • Export Citation
  • 63.

    Weidler DJ: Myocardial damage and cardiac arrhythmias after intracranial hemorrhage. A critical review. Stroke 5:759764, 1974 Weidler DJ: Myocardial damage and cardiac arrhythmias after intracranial hemorrhage. A critical review. Stroke 5:759–764, 1974

    • Search Google Scholar
    • Export Citation
  • 64.

    Weintraub BM, & McHenry LC Jr: Cardiac abnormalities in subarachnoid hemorrhage: a resume. Stroke 5:384392, 1974 Weintraub BM, McHenry LC Jr: Cardiac abnormalities in subarachnoid hemorrhage: a resume. Stroke 5:384–392, 1974

    • Search Google Scholar
    • Export Citation
  • 65.

    White M, , Wiechmann RJ, & Roden RL, et al: Cardiac beta-adrenergic neuroeffector systems in acute myocardial dysfunction related to brain injury. Evidence for catecholamine-mediated myocardial damage. Circulation 92:21832189, 1995 White M, Wiechmann RJ, Roden RL, et al: Cardiac beta-adrenergic neuroeffector systems in acute myocardial dysfunction related to brain injury. Evidence for catecholamine-mediated myocardial damage. Circulation 92:2183–2189, 1995

    • Search Google Scholar
    • Export Citation
  • 66.

    Zaroff JG, , Rordorf GA, & Newell JB, et al: Cardiac outcome in patients with subarachnoid hemorrhage and electrocardiographic abnormalities. Neurosurgery 44:3440, 1999 Zaroff JG, Rordorf GA, Newell JB, et al: Cardiac outcome in patients with subarachnoid hemorrhage and electrocardiographic abnormalities. Neurosurgery 44:34–40, 1999

    • Search Google Scholar
    • Export Citation
  • 67.

    Zaroff JG, , Rordorf GA, & Ogilvy CS, et al: Regional patterns of left ventricular systolic dysfunction after subarachnoid hemorrhage: evidence for neurally mediated cardiac injury. J Am Soc Echocardiogr 13:774779, 2000 Zaroff JG, Rordorf GA, Ogilvy CS, et al: Regional patterns of left ventricular systolic dysfunction after subarachnoid hemorrhage: evidence for neurally mediated cardiac injury. J Am Soc Echocardiogr 13:774–779, 2000

    • Search Google Scholar
    • Export Citation
  • 68.

    Zaroff JG, , Rordorf GA, & Titus JS, et al: Regional myocardial perfusion after experimental subarachnoid hemorrhage. Stroke 31:11361143, 2000 Zaroff JG, Rordorf GA, Titus JS, et al: Regional myocardial perfusion after experimental subarachnoid hemorrhage. Stroke 31:1136–1143, 2000

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 573 136 12
Full Text Views 194 6 0
PDF Downloads 98 12 0
EPUB Downloads 0 0 0