Enfermedad cardíaca en los hematomas intracerebrales
Introduction and objective. The Central Nervous System (CNS) plays an essential role in the regulation of the cardiac function. There is strong evidence that many CNS lesions, mainly those of hemorrhagic origin, may induce repolarization abnormalities and enlargement of the QT interval (ECG changes) and several types of arrhythmias. In some cases these changes have been related to sudden death. The imbalance between the sympathetic and parasympathetic systems, favoring the former, seems to be the etiopathogenic factor. Material and methods. We have carried out a study on thirty-two in-patients suffering from non-severe intracerebral hemorrhage, by means of a Holter ECG examination within the first 72 hours and a second record after two months. We have assessed any significative differences on the ECG findings in relation to the location of the hematoma (leftor right hemispheres) and the presence of a personal history of arterial hypertension and/or heart disease. Results. One or more ECG changes were present in 69,2% of the patients and 73% showed one or more rhythm abnormalities. There was a higher incidence of supraventricular arrhythmias associated with the right hemisphere hematomas, with an statistical significance for the atrial extrasystolia. No differences were found between the group with a previous history of hypertension and/or heart disease and the one without these conditions. There were two cases of sudden death, both with left hemisphere hematomas, and in one of them the previous rhythm abnormalities were recorded. Conclusions. This study corroborates the hypothesis that right hemispheric hematomas induce supraventricular arrhythmias more frequently. The possibble association between severe ventricular arrhythmias and sudden death with left-hemisferic hematomas should be studied in a higher number of patients. We recommend monitoring every acute case of intracerebral hematoma when possible
Resultados Un 69,2% de los pacientes presentó uno o más cambios ECG y un 73% una o más alteraciones del ritmo. En los hematomas derechos había una mayor frecuencia de arritmias supraventriculares con significación estadística para las extrasístoles auriculares. No hubo diferencias entre el grupo con antecedentes de HTA y/o cardiopatía y el que no tenía estos antecedentes. Dos pacientes fallecieron de muerte súbita, ambos con hematomas izquierdos, y en uno de ellos se registraron en el Holter las alteraciones del ritmo previas al éxitus.
Conclusiones Este estudio viene a corroborar la hipótesis de que los hematomas derechos inducen con mayor frecuencia arritmias supraventriculares. La posible asociación de arritmias ventriculares graves y muerte súbita con hematomas izquierdos debería ser estudiada con un mayor número de pacientes. En los hospitales donde fuera posible, sería recomendable monitorizar todo hematoma cerebral en la fase aguda
