Relation of ECG Abnormalities to Clinical Severity and Troponin I Changes in Patients with Subarachnoid Hemorrhage

Background: Subarachnoid hemorrhage (SAH) is a devastating condition. Aside from its neurological morbidities, SAH is associated with significant medical complications. Subarachnoid hemorrhage frequently results in myocardial injury with electrocardiographic (ECG) abnormalities and release of cardiac troponin I. This myocardial injury after SAH is a neurally mediated process that is dependent on the severity of neurological injury. Objectives: This study was designed to determine ECG changes in patients with SAH and these changes were compared with neurological severity as well as elevated troponin I levels. Patients and methods: This cross-sectional descriptive study was conducted over 30 patients with SAH. Demographic (age, sex), hemodynamic (pulse, systolic and diastolic blood pressure) and neurological (GCS, WFNS score) information were recorded. We evaluated their onadmission ECG and Troponin I levels. Results: Out of 30 patients, at least one morphological ECG abnormality was present in 17 patients (56.7%) and a total of 21 different abnormalities were present. There were no significant associations between the number or type of observed ECG abnormalities and WFNS grade. But there was a statistically significant correlation between ischemic like ECG changes and elevated troponin I (p = 0.035). The presence of T inversion also significantly explained an elevated Troponin I concentration (46.2%, p = 0.035). Conclusion: ECG changes are prevalent in acute SAH. Ischemic like ECG changes are related to an increase in Troponin I, suggesting that these ECG changes may indicate neurocardiogenic cause of cardiac injury after SAH.