Polymorphic Ventricular Tachycardia and Repolarization Abnormalities Accompanying Intracerebral Hemorrhage
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.
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.
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.
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