Electrocardiographic abnormalities in patients with cerebrovascular disease

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Cerebral damage is frequently accompanied by ECG changes that consist mostly in repolarization disturbance in patients without coronary artery disease. Repolarization changes consist of sometimes dramatic ST segment elevations and inverted T waves in patients with normal hearts. These alterations resemble those of ischemic heart disease and may cause diagnostic mistakes.

We selected and studied 23 patients, 14 men and 9 women, mean age 63 ± 4 years, with recent stroke. Each patient underwent standard ECG, cardiac enzymes, M-mode and 2-D echocardiography and Doppler. On ECG, all patients presented inverted T waves and no alterations of ST segment. Cardiac enzymes were in the normal range and echocardiogram showed no wall motion abnormalities. Only 13 patients underwent coronary arteriography and all had normal coronary arteriograms.

Our findings confirm previous reports that associate acute cerebral accidents and repolarization abnormalities.

There is little information regarding a relationship between specific stroke location and disturbances in repolarization in humans, but there is substantial evidence that `catecholamine storm', characterized by copious release of norepinephrine from cardiac β-1 receptor sites, during acute cerebral accidents is responsible for myocardial damage reflected in sub-endocardial injury.