• Intracranial Hypertension
• Stress Cardiomyopathy
• ECG and Intracranial Hypertension

Intracranial Hypertension

• Severe intracranial hypertension (regardless of etiology)
• Stimulates the hypothalamus (Autonomic nervous system)
• Releases catecholamines (Adrenaline, Norepinephrine)
• Most common causes:
• Subarachnoid hemorrhage
• Intracranial hemorrhage
• Ischemic stroke
• Head trauma
• Brain metastases
• Brain tumors
• Catecholamine storm
• Occurs with massive release of catecholamines
• Represents extreme activation of the sympathetic nervous system
• Cushing's reflex
• It is a physiological response of the CNS to intracranial hypertension
• Results in a triad:
• Sinus bradycardia
• Arterial hypertension
• Irregular breathing

ECG and Intracranial Hypertension

• ECG changes primarily associated with intracranial hypertension include:
• Subarachnoid Hemorrhage (SAH)
• 72% of patients with SAH show ECG changes
• Intracranial Hemorrhage (ICH)
• 57% of patients with ICH show ECG changes
• ECG changes may persist for 2 to 8 weeks
  
  
• Main ECG changes associated with intracranial hypertension:
• Cerebral T Waves (wide deep T waves)
• Prolonged QT Interval
• Bradycardia due to Cushing Reflex
  
  
• Secondary ECG changes:
• ST Elevations and ST Depressions
• May resemble myocardial infarction
• Increased U Waves ( >1mm )
• Intracranial hemorrhage may resemble acute myocardial infarction!
• Patient must not receive anticoagulant and thrombolytic treatment for infarction!

• Cerebral T Wave
• Prolonged QT Interval

Subarachnoid Hemorrhage

• Cerebral T Waves (V2-V6, II)
• Prolonged QT Interval (0.6s)
• Bradycardia is not present
• Heart Rate 60/min.

Subarachnoid Hemorrhage

• Cerebral T Waves (V3-V5)
• Mild ST Depression (V3-V5, II)
• Prolonged QT Interval
• Corrected QT (0.5s)
• QT is more than half of the RR interval
• Possible ECG findings include:
• Intracranial Hypertension
• Ischemic Changes
• Wellens Syndrome
• The patient had headache, and CT scan of the head showed subarachnoid hemorrhage