Changes of Electrocardiogram and Cardiac Enzymes in Acute Ischemic Stroke

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1 Changes of Electrocardiogram and Cardiac Enzymes in Acute Ischemic Stroke Yong-Seok Jang, M.D., Ji-Won Min, M.D., Bong-Goo Yoo, M.D., Kwang-Soo Kim, M.D., Kyung-Moo Yoo, M.D. Department of Neurology, Kosin University College of Medicine B a c k g r o u n d : Cardiac arrhythmias and other cardiac dysfunctions occur in relation with acute cerebral ischemia. This study was undertaken to evaluate the sequential changes of electrocardiogram and cardiac enzymes after acute ischemic stroke, and to evaluate the incidence of cardiac arrhythmias. M e t h o d s : Forty-three patients with acute ischemic stroke were recruited for this study. Electrocardiogram and cardiac enzymes were checked at 1, 3, 5, 7, 15, and 30 days after onset. Results : Heart rates were decreased acutely after ischemic stroke and showed maximal decrease at day 3 (p<0.05). Heart rates were more significantly decreased in the right-sided lesions than the left (p<0.05) and in the supratentorial lesions than the infratentorial (p<0.05). PR intervals and durations of QRS complex were prolonged at day 3 and 5 but were not significant. The prolongation of the QTc interval was found in 21 patients (48.8%) and sustained QTc prolongation at day 30 were seen in 16 patients. Compared with controls, patients showed significantly higher incidence of arrhythmias (p<0.01). Creatine phosphokinase-mb (CK-MB) was significantly increased at day 5 (p<0.01) and lactic dehydrogenase (LDH) was increased at day 7 (p<0.01). Conclusions : In our study, the incidence of neurogenic cardiac abnormalities in acute ischemic stroke was higher than that of previous studies. Abnormalities peaked at days 3 and 5 were nearly similar to control levels at day 30. These periods of peak abnormalities coincided with those of increasing brain edema. Therefore, we postulate that cardiac autonomic controls are also influenced by acute brain edema. J Korean Neurol Assoc 19(3):207~212, 2001 Key Words : Cerebral infarction, Neurogenic heart disease, Electrocardiogram, Cardiac enzymes Kyung Moo Yoo, M.D. Copyright 2001 by the Korean Neurological Association 207

2 Figure 1. Sequential changes of heart rate and comparison of heart rate between right and left hemispheric lesions. Heart rate is significantly decreased at day 3 after stroke onset (P<0.05), and then gradually increased nearly control level. Right hemspheric lesion shows significantly decreased heart rate than left one (P<0.05). 208 J Korean Neurol Assoc / Volume 19 / May, 2001

3 Table 1. The results of heart rate and PR interval in acute ischemic stroke patients Total Site (n=43) Right(n=16) Left(n=22) Heart rate 1 day day day day day day P value* PR interval 1 day day day day day day P value* *Statistical significance test is done by repeated measures ANOVA test within patients group. Table 2. Spectrum of electrocardiogram changes in acute ischemic stroke patients Patients(n=43) Control(n=44) Depolarization-repolarization abnormality Peaked P wave 11(12.3%) 0 Pathologic Q wave 15(11.6%) 0 Depressed or raised ST segment 19(44.2%) 0 Prolonged QT interval 22(51.2%) 3(6.8%) Tall or deep and inverted T wave 19(44.2%) 1(2.3%) U wave 12(14.2%) 0 Conduction abnormality First-, second-, and/or third-degree AV block 11(12.3%) 0 Intraventricular conduction defect 13(17.0%) 0 Sinus dysrhythmias Sinus bradycardia 18(41.9%) 0 Sinus tachycardia 13(30.2%) 0 Supraventricular dysrhythmias Atrial premature complexes 14(19.3%) 1(2.3%) Atrial fibrillation/flutter 11(25.6%) 1(2.3%) Supraventricular tachycardia 11(12.3%) 0 Sinus arrhythmia 11(12.3%) 0 Ventricular dysrhythmias Ventricular premature complexes 13(17.0%) 1(2.3%) AV; atrioventricular J Korean Neurol Assoc / Volume 19 / May,

4 unit is equal to 2.4 mg% CK-MB and mg% LDH. CK- Figure 2. Sequential changes of creatine phosphokinase-mb (CK-MB) and lactate dehydrogenase (LDH). Arbitrary unit, 1 MB and LDH are significantly increased at days 5 and 7 days after stroke onset, respectively (P<0.01 and P<0.01). Table 3. The results of serum cardiac enzymes in acute ischemic stroke patients Total Site Size (n=43) Right(n=16) Left(n=22) L or M(n=16) Small(n=17) CK-MB 1 day day day day day day P value* LDH 1 day day day day day day P value* AST 1 day day day day day day P value* *Statistical significance test is done by repeated measures ANOVA test within patients group. Repeated measures ANOVA used for comparison between large and small lesion during 30 day Repeated measures ANOVA used for comparison between large and small lesion during 15 day CK-MB; creatine phosphokinase-mb, LDH; lactic dehydrogenase, AST; aspartate transaminase, L or M; large or medium 210 J Korean Neurol Assoc / Volume 19 / May, 2001

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