Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 6, 2019; 7(21): 3603-3614
Published online Nov 6, 2019. doi: 10.12998/wjcc.v7.i21.3603
Myocardial ischemic changes of electrocardiogram in intracerebral hemorrhage: A case report and review of literature
Xue-Qi Lin, Liang-Rong Zheng
Xue-Qi Lin, Liang-Rong Zheng, Department of Cardiovascular, The First Affiliated Hospital of Zhejiang University, Hangzhou 310003, Zhejiang Province, China
Author contributions: Lin XQ and Zheng LR contributed equally to this work; Lin XQ wrote the paper; Zheng LR reviewed and edited the paper.
Informed consent statement: Informed consent was obtained from the patient to publish relevant date.
Conflict-of-interest statement: The authors declare that there is no conflict of interest regarding the publication of this paper.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Liang-Rong Zheng, MD, Department of Cardiovascular, The First Affiliated Hospital of Zhejiang University, Qingchun Road, No. 79, Hangzhou 310003, Zhejiang Province, China. 1191066@zju.edu.cn
Telephone: +86-18259025955
Received: June 1, 2019
Peer-review started: June 4, 2019
First decision: September 9, 2019
Revised: September 22, 2019
Accepted: October 5, 2019
Article in press: October 5, 2019
Published online: November 6, 2019
Abstract
BACKGROUND

Cardiac injury may occur after acute pathology of central nervous system (CNS) without any evidence of primary cardiac diseases. The resulting structural and/or functional changes are called cerebrocardiac syndrome (CCS). The great majority of studies have been performed in patients with subarachnoid hemorrhage (SAH), while CCS data after intracerebral hemorrhage (ICH) are rare. It may cause diagnostic and therapeutic pitfalls for the clinician due to a lack of specific clinical manifestations and diagnostic methods. Understanding the underlying pathophysiological and molecular mechanism(s) following cerebrovascular incidents will help to implement prevention and treatment strategies to improve the prognosis.

CASE SUMMARY

A 37-year-old man with a history of hypertension presented to our department on an emergency basis because of a sudden dizziness and left limb weakness. Cerebral computed tomography (CT) suggested ICH in the occipital and parietal lobes, and the chosen emergency treatment was hematoma evacuation. Left ventricular (LV) dysfunction occurred after the next 48 h and the electrocardiogram (ECG) showed non-ST elevation myocardial infarction. CCS was suspected first in the context of ICH due to the negative result of the coronary CT angiogram.

CONCLUSION

Misinterpretation of ischemic-like ECGs may lead to unnecessary or hazardous interventions and cause undue delay of rehabilitation after stroke. Our objective is to highlight the clinical implications of CCS and we hope the differential diagnoses will be considered in patients with acute CNS diseases.

Keywords: Stroke, Intracerebral hemorrhage, Cerebrocardiac syndrome, Cardiac insufficiency, Non-ST elevation myocardial infraction, Case report, Neurogenic stunned myocardium

Core tip: Acute stroke (AS)-induced cardiac injury is of utmost clinical importance. The data of cerebrocardiac syndrome (CCS) after intracerebral hemorrhage are few. We report a case of ischemic electrocardiogram changes in acute cerebral hemorrhage and systematically review the mechanisms and characteristics of CCS in the setting of AS and raise awareness of CCS among physicians.