PROGNOSTIC SIGNIFICANCE OF ELECTROCARDIOGRAPHY AND ECHOCARDIOGRAPHY IN PATIENTS OF ACUTE STROKE

M. Indurkar, R. K. Kewat, K. D. Singh

Abstract


INTRODUCTION: World Health Organization (WHO) definition of stroke is: “rapidly developing clinical signs of focal
(or global) disturbance of cerebral function, with symptoms lasting 24 hours or longer or leading to death, with no
apparent cause other than of vascular origin Cerebrovascular accident (CVA) or stroke is the most common life
threatening or disabling neurological condition in older population. CVA is often associated with ECG changes and wall
motion abnormalities on 2D echo. The changes of ECG in CVA were reported were T-wave, U-wave, ST-segment, QTinterval
and various arrhythmias, these ECG changes may resemble those of myocardial ischemia or sometime
myocardial infarction. The aim of this study is to assess the different changes in ECG and echocardiographic patterns in
the cases of cerebrovascular accidents and to determine whether these different changes have got any prognostic
significance in these cases.
METHOD: 200 patients of acute stroke were considered and ECG and 2D echo of these patients were done within 24
hours of admission. In hospital follow-up was done to know the prognosis of all the patients.
RESULTS: ECG abnormalities noted among cerebral infarct group were presence of U- waves (51.47%), prolonged QTc
(36.76%) were most common followed by T-wave inversion (30.88%), and ST segment depression (30.88%). In cases of
hemorrhagic stroke, ST depression (56.26%) and U-wave (56.26%) were the most common abnormalities. LV
dysfunction was the most common 2D echo abnormality in both the stroke types – 23.53% and 81.8% i.e., in infarct and
hemorrhage groups respectively. Mortality was high in patients with abnormal ECG (24%) as compared to normal ECG
(17.2%) (p>0.5). Mortality was high in patients with abnormal 2D echocardiography (90.91%) as compared to normal
2D ECHO(9.09%) (p<0.001).
CONCLUSION: ST segment depression, QTc prolongation and U-waves are the common ECG abnormalities in
hemorrhagic strokes. QTc prolongation and U-waves are the common ECG abnormality in ischemic stroke. LV dysfunction
is the most common 2D echocardiographic abnormality in stroke patients. ECG abnormalities in stroke patients do not have
any prognostic significance. LV dysfunction has prognostic significance in predicting mortality in CVA.


Keywords


Stroke; Ecg; 2d Echocardiography.

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