title: Cardiac abnormalities after aneurysmal subarachnoid hemorrhage: effects of β-blockers and angiotensin-converting enzyme inhibitors.
abstract: BACKGROUND
  Cardiac abnormalities attributed to adrenergic surge are common after aneurysmal subarachnoid hemorrhage. Prescribed medications that block adrenergic stimulation may suppress the onset of cardiopulmonary compromise in patients after aneurysmal subarachnoid hemorrhage.
  
  
  OBJECTIVE
  To compare the incidence of early cardiac complications between patients who reported prescribed use of β-blockers and/or angiotensin-converting enzyme inhibitors before aneurysmal subarachnoid hemorrhage and patients who did not.
  
  
  METHODS
  A retrospective review of 254 adult patients after acute aneurysmal subarachnoid hemorrhage who were enrolled in an existing R01 study. Demographic data and history were obtained from patients'/proxies' reports and charts. Cardiac enzyme levels, 12-lead electrocardiograms, and chest radiographs were obtained on admission. Holter monitoring and echocardiograms were completed as a part of the R01 study.
  
  
  RESULTS
  Patients reporting prescribed use of angiotensin-converting enzyme inhibitors or β-blockers before aneurysmal subarachnoid hemorrhage had more ventricular and supraventricular ectopy on a Holter report than did patients who did not (P < .05). When age, race, sex, and injury (Fisher grade) were controlled for, patients reporting use of β-blockers were 8 times more likely than others to have occasional to frequent ventricular ectopy (P = .02).
  
  
  CONCLUSIONS
  No concrete evidence was found that exposure to adrenergic blockade before aneurysmal subarachnoid hemorrhage provides protection from neurocardiac injury.
authors.affiliation: Elizabeth Crago is a research assistant professor and Kelly Kerris is an acute care clinical nurse specialist currently working on her post-master's ACNP certificate at the University of Pittsburgh, School of Nursing, Pittsburgh, Pennsylvania. Chien-Wen J. Kuo is a biostatistician at Columbia University, New York, New York. Paula Sherwood is a professor and the vice chair for research and Marilyn Hravnak is a professor in the Acute/Tertiary Care Department at the University of Pittsburgh, School of Nursing. David Crippen is a critical care medicine physician and codirector of the neurovascular intensive care unit at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. Michael Horowitz is a neurological surgeon and the codirector of the Pennsylvania Brain and Spine Institute, Pittsburgh, Pennsylvania.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Crago
authors.forename: Kelly
authors.initials: K
authors.lastname: Kerris
authors.forename: Chien-Wen J
authors.initials: CW
authors.lastname: Kuo
authors.forename: Paula
authors.initials: P
authors.lastname: Sherwood
authors.forename: Marilyn
authors.initials: M
authors.lastname: Hravnak
authors.forename: David
authors.initials: D
authors.lastname: Crippen
authors.forename: Michael
authors.initials: M
authors.lastname: Horowitz
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D000328:Adult; D017677:Age Distribution; D000368:Aged; D017542:Aneurysm, Ruptured / Q000150:complications*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D002317:Cardiovascular Agents / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D005260:Female; D006321:Heart / Q000187:drug effects / Q000503:physiopathology*; D006331:Heart Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D017678:Sex Distribution; D013345:Subarachnoid Hemorrhage / Q000150:complications* / Q000209:etiology; D016019:Survival Analysis; D055815:Young Adult
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D002317:Cardiovascular Agents