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(Circulation. 2000;101:e81.)
© 2000 American Heart Association, Inc.

Circulation Electronic Pages

Polymorphic Ventricular Tachycardia and Repolarization Abnormalities Accompanying Intracerebral Hemorrhage

Haim D. Danenberg, MD; Yonathan Hasin, MD

From the Department of Cardiology, Hadassah University Hospital, Jerusalem, Israel.

Correspondence to Haim D. Danenberg, Department of Cardiology, Hadassah University Hospital, POB 12000, Jerusalem, Israel 91120. E-mail danen@md2.huji.ac.il

	Introduction

 
A70-year-old patient with no apparent heart disease was admitted after a motor-vehicle accident and had right hemispheric intracerebral hemorrhage with compression over the lateral ventricle (Figure 1). The patient was admitted to an intensive care unit, where an ECG was taken. ECG repolarization abnormalities were followed by repeated runs of nonsustained polymorphic ventricular tachycardia (torsade de pointes) (Figure 2), which caused hemodynamic instability. Intravenous magnesium sulfate was administered, and the ECG changes subsided promptly (Figure 3). An exercise test performed a few weeks later was negative for ischemia.

View larger version (92K): [in this window] [in a new window]   Figure 1. CT scan demonstrating right hemispheric intracerebral hemorrhage.

View larger version (85K): [in this window] [in a new window]   Figure 2. ECG performed 12 hours after trauma. Deep, symmetrical T-wave inversion in precordial leads, followed by nonsustained polymorphic ventricular tachycardia.

View larger version (82K): [in this window] [in a new window]   Figure 3. An ECG performed 10 minutes after administration of intravenous magnesium sulfate, showing no repolarization abnormalities.

Life-threatening arrhythmias, including atrioventricular blocks, ventricular tachycardia, and fibrillation, may accompany acute cerebral accidents in patients without cardiac disease. Therefore, after acute cerebrovascular events, patients should be constantly monitored, and the treating team should be familiar with and well-trained in the diagnosis and treatment of cardiac arrhythmias.

	Footnotes

 
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.

Circulation encourages readers to submit cardiovascular images to Dr Hugh A. McAllister, Jr, St Luke’s Episcopal Hospital and Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.