Left Ventricular Wall Motion Abnormalities in Subarachnoid Hemorrhage: An Echocardiographic Study

Although electrocardiographic (ECG) abnormalities and autopsy evidence of myocardial necrosis are associated with subarachnoid hemorrhage, their relation to in vivo measures of left ventricular function in this condition has not been established. Thirteen patients with subarachnoid hemorrhage and no prior history of heart disease were studied by two-dimensional echocardiography, performed initially 10 to 48 h (mean 18) after admission and serially for ≤14 days. Serum creatine kinase (total and myocardial isoenzyme) was determined 5 times over the first 48 h; ECGs were performed daily. Neurologic state was assessed with the use of a standard grading system.Four patients (Group I) exhibited left ventricular wall motion abnormalities in one to eight segments. In two of these patients there was also left ventricular apical mural thrombus that embolized in one patient, leading to further neurologic deterioration. The initial creatine kinase myocardial isoenzyme was higher in Group I than in Group II (patients without wall motion abnormalities) (10.3 versus 2.1 U/liter, p < 0.001), initial heart rate was higher (91 versus 61 beats/min, p < 0.01), neurologic grade was higher (2.5 to 4.5 versus 1 to 2, p < 0.001) and inverted T waves were more common (4 of 4 versus 1 of 9). Three of the four patients in Group I died; two of the three underwent autopsy and were found to have no significant coronary artery disease. No other patients died.From this series it appears that subarachnoid hemorrhage with a high neurologic grade is often accompanied by left ventricular wall motion abnormalities that may contribute to morbidity and mortality in such patients. These abnormalities are readily detected by two-dimensional echocardiography