318 Study of the Clinical, ECG and Biochemical Spectrum of Cardiovascular Complications in Patients of Aneurysmal Subarachnoid Haemorrhage An Initial Experience at a Tertiary Centre in India

Abstract

Abstract INTRODUCTION Subarachnoid haemorrhage (SAH) following aneurysmal rupture is an extremely fatal condition with mortality as high as 45%. Apart from the intra-cranial causes, there are cardiovascular events which add to the morbidity and mortality. Eg: myocardial ischemia, arrhythmia's and heart blocks. These can manifest with deranged cardiac biomarkers. However, quantitative assessment of these biochemical markers and its co-relation with prognosis in patients of aneurysmal SAH has not been adequately studied. METHODS After obtaining ethical clearance, we conducted a prospective observational study in our department. The study included all patients of aneurysmal SAH with ictus less than 48 hours at the time of admission.Excluded were patients with past history of coronary artery disease or cardiac surgery. The patient's heart rate, blood pressure, pupillary response, GCS Score, any neurodeficits, cranial nerve palsies, Hunt and Hess/WFNS grade of SAH were noted on admission. Serum cardiac enzymes (Troponin T, Total creatine phosphokinase, cardiac specific creatine phosphokinase), serum brain natriuretic peptide (BNP) and C reactive protein levels were done for 6 consecutive days from the day of admission. Patient also underwent a 12 lead ECG and 2D Echocardiography on days 0, 1 and 5. RESULTS >Serum levels of troponin T, total creatine phosphokinase and BNP were statistically associated with outcome. Abnormal levels of these markers were associated with a poor outcome. ECG abnormalities were observed in 76% of the cases. Prolonged QTc interval was the most common abnormal ECG finding among the patients who died. One patient developed 3rd degree heart block following aneurysmal SAH and another patient developed left ventricular dysfunction with an ejection fraction of 40%. CONCLUSION Cardiovascular complications are common in patients of aneurysmal SAH. Serum quantitative levels of Troponin T, total creatine phosphokinase and BNP show statistical significant association with outcome and can be incorporated in the battery of tests in SAH patients for predicting outcome.