EKG changes in ruptured aneurysms

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1. 27-100 % of patients with subarachnoid hemorrhage have electrocardiographic abnormalities
   1. T wave abnormalities – 50%
   2. QT prolongation (also associated with quinidine toxicity) – 40%
   3. ST segment changes – 30% (most characteristic finding in subendocardial ischemia is ST depression while transmural ischemia leads to ST elevation – Remember: ST elevation is the ‘gravestone’ sign)
   4. prominent U waves – 25%
   5. rhythm disturbances – 35%
2. basis of changes is thought to be subendocardial ischemia, hemorrhages, and focal areas of myocardial necrosis due to increases in sympathetic tone and norepinephrine levels
3. there is no correlation between the electrocardiogram changes and changes of the myocardium on echocardiograms
   1. myocardial dysfunction is most closely related to the patient’s neurologic grade