[Neurogenic cardiac arrhythmias in acute intracranial increase in pressure (recurrent hemorrhage in subarachnoid hemorrhages)].
Neurogenic cardiac arrhythmias during 5 cases of subarachnoid rebleeding in 4 patients were analyzed by using long-term ECG (Holter). The initial onset of rebleeding was characterized by an abrupt decrease of heart rate from 93.3 +/- 7.85 (beats/min) to 63.3 +/- 14.6 (beats/min). This was immediately followed by pronounced tachycardia of 163.0 +/- 20.9 (beats/min) and subsequently, alterations of the P wave, ST depression with an increase in T wave amplitude. Frequent premature ventricular contractions, couplets, and self-terminating episodes of ventricular tachycardia for 2-8 minutes were observed during 2 episodes of rebleeding, an idioventricular rhythm in one case. The ECG returned to normal in the 3 non-lethal cases. Pathogenetically, the initial heart rate decrease with varying P wave configuration can be explained through activation of the baroreceptor reflex. Elevated intracranial pressure causes a blood pressure increase thus stimulating the baroreceptors and consequently, the afferent and efferent tracts of the vagus nerve. The sympathicotonus appears to have a modulating effect.
D000328:Adult; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000209:etiology*; D005117:Cardiac Complexes, Premature / Q000209:etiology; D004562:Electrocardiography; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications; D002532:Intracranial Aneurysm / Q000150:complications; D007427:Intracranial Pressure; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D013345:Subarachnoid Hemorrhage / Q000150:complications*; D013616:Tachycardia, Sinus / Q000209:etiology; D014057:Tomography, X-Ray Computed
Neurogene kardiale Arrhythmien bei akutem intrakraniellem Druckanstieg (Nachblutungen bei Subarachnoidalblutungen).