Myocardial injury associated with CNS disease

Myocardial injury associated with CNS disease

What is the nature of the myocardial injury associated with CNS disease? 

CNS lesions, particularly intracerebral and subarachnoid hemorrhage, may cause a number of electrocardiogram (ECG) abnormalities suggestive of myocardial ischemia.

These changes may closely resemble myocardial infarction and include prolongation of the QT interval, ST segment depression, flattening or inversion of T waves, and the appearance of U waves.

With the exception of QT interval prolongation and the U waves, these changes usually revert to normal within 2 weeks after the CNS event.

Other less frequently observed ECG changes are increased amplitude of the P wave, development of Q waves, ST segment elevation, and T wave elevation, notching, or peaking.

Differentiation between a centrally induced ECG abnormality and a true myocardial infarction may be difficult, but the patient must be cared for in a monitored setting until a “true” myocardial infarction is excluded.

The ECG changes are thought to be due to a neurogenically mediated excessive release of catecholamines upon cardiac myocytes, resulting in myonecrotic changes.

In fact, a higher level of serum catecholamines correlates with a poor outcome in patients with subarachnoid hemorrhage

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