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A Narrative Review of Cardiovascular Abnormalities After Spontaneous Intracerebral Hemorrhage.

Publication ,  Journal Article
Lele, A; Lakireddy, V; Gorbachov, S; Chaikittisilpa, N; Krishnamoorthy, V; Vavilala, MS
Published in: J Neurosurg Anesthesiol
April 2019

BACKGROUND: The recommended cardiac workup of patients with spontaneous intracerebral hemorrhage (ICH) includes an electrocardiogram (ECG) and cardiac troponin. However, abnormalities in other cardiovascular domains may occur. We reviewed the literature to examine the spectrum of observed cardiovascular abnormalities in patients with ICH. METHODS: A narrative review of cardiovascular abnormalities in ECG, cardiac biomarkers, echocardiogram, and hemodynamic domains was conducted on patients with ICH. RESULTS: We searched PubMed for articles using MeSH Terms "heart," "cardiac," hypertension," "hypotension," "blood pressure," "electro," "echocardio," "troponin," "beta natriuretic peptide," "adverse events," "arrhythmi," "donor," "ICH," "intracerebral hemorrhage." Using Covidence software, 670 articles were screened for title and abstracts, 482 articles for full-text review, and 310 extracted. A total of 161 articles met inclusion and exclusion criteria, and, included in the manuscript. Cardiovascular abnormalities reported after ICH include electrocardiographic abnormalities (56% to 81%) in form of prolonged QT interval (19% to 67%), and ST-T changes (19% to 41%), elevation in cardiac troponin (>0.04 ng/mL), and beta-natriuretic peptide (BNP) (>156.6 pg/mL, up to 78%), echocardiographic abnormalities in form of regional wall motion abnormalities (14%) and reduced ejection fraction. Location and volume of ICH affect the prevalence of cardiovascular abnormalities. Prolonged QT interval, elevated troponin-I, and BNP associated with increased in-hospital mortality after ICH. Blood pressure control after ICH aims to preserve cerebral perfusion pressure and maintain systolic blood pressure between 140 and 179 mm Hg, and avoid intensive blood pressure reduction (110 to 140 mm Hg). The recipients of ICH donor hearts especially those with reduced ejection fraction experience increased early mortality and graft rejection. CONCLUSIONS: Various cardiovascular abnormalities are common after spontaneous ICH. The workup of patients with spontaneous ICH should involve 12-lead ECG, cardiac troponin-I, as well as BNP, and echocardiogram to evaluate for heart failure. Blood pressure control with preservation of cerebral perfusion pressure is a cornerstone of hemodynamic management after ICH. The perioperative implications of hemodynamic perturbations after ICH warrant urgent further examination.

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Published In

J Neurosurg Anesthesiol

DOI

EISSN

1537-1921

Publication Date

April 2019

Volume

31

Issue

2

Start / End Page

199 / 211

Location

United States

Related Subject Headings

  • Subarachnoid Hemorrhage
  • Humans
  • Electrocardiography
  • Echocardiography
  • Cerebral Hemorrhage
  • Cardiovascular Abnormalities
  • Anesthesiology
  • 3202 Clinical sciences
  • 1701 Psychology
  • 1103 Clinical Sciences
 

Citation

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Lele, A., Lakireddy, V., Gorbachov, S., Chaikittisilpa, N., Krishnamoorthy, V., & Vavilala, M. S. (2019). A Narrative Review of Cardiovascular Abnormalities After Spontaneous Intracerebral Hemorrhage. J Neurosurg Anesthesiol, 31(2), 199–211. https://doi.org/10.1097/ANA.0000000000000493
Lele, Abhijit, Viharika Lakireddy, Sergii Gorbachov, Nophanan Chaikittisilpa, Vijay Krishnamoorthy, and Monica S. Vavilala. “A Narrative Review of Cardiovascular Abnormalities After Spontaneous Intracerebral Hemorrhage.J Neurosurg Anesthesiol 31, no. 2 (April 2019): 199–211. https://doi.org/10.1097/ANA.0000000000000493.
Lele A, Lakireddy V, Gorbachov S, Chaikittisilpa N, Krishnamoorthy V, Vavilala MS. A Narrative Review of Cardiovascular Abnormalities After Spontaneous Intracerebral Hemorrhage. J Neurosurg Anesthesiol. 2019 Apr;31(2):199–211.
Lele, Abhijit, et al. “A Narrative Review of Cardiovascular Abnormalities After Spontaneous Intracerebral Hemorrhage.J Neurosurg Anesthesiol, vol. 31, no. 2, Apr. 2019, pp. 199–211. Pubmed, doi:10.1097/ANA.0000000000000493.
Lele A, Lakireddy V, Gorbachov S, Chaikittisilpa N, Krishnamoorthy V, Vavilala MS. A Narrative Review of Cardiovascular Abnormalities After Spontaneous Intracerebral Hemorrhage. J Neurosurg Anesthesiol. 2019 Apr;31(2):199–211.

Published In

J Neurosurg Anesthesiol

DOI

EISSN

1537-1921

Publication Date

April 2019

Volume

31

Issue

2

Start / End Page

199 / 211

Location

United States

Related Subject Headings

  • Subarachnoid Hemorrhage
  • Humans
  • Electrocardiography
  • Echocardiography
  • Cerebral Hemorrhage
  • Cardiovascular Abnormalities
  • Anesthesiology
  • 3202 Clinical sciences
  • 1701 Psychology
  • 1103 Clinical Sciences