Clinical Presentation to the Emergency Department Predicts Subarachnoid Hemorrhage-Associated Myocardial Injury.
Khalil M Yousef, Elizabeth Crago, Theodore F Lagattuta and 1 others
PMID 28712527WHAT IT FOUND
Emergency department patients with aneurysmal subarachnoid hemorrhage who were unresponsive at the time of bleeding, had a poor Hunt and Hess grade, a low Glasgow Coma Scale score, or a prolonged QTc interval on their initial ECG had significantly higher odds of developing myocardial injury.
Key findings
01Poor Hunt and Hess grade and unresponsiveness at the time of bleeding were associated with a 4.01-fold and 3.04-fold increased odds of subarachnoid hemorrhage-associated myocardial injury, respectively.
02For every one unit decrease in admission Glasgow Coma Scale score, the odds of myocardial injury increased by 17%, and for every one millisecond increase in the corrected QT interval, the odds increased by 1%.
03Patients with myocardial injury were less likely to report headache and more likely to display seizure or unresponsiveness compared to those without myocardial injury.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study recruited patients over a 12-year period, which may have introduced variations in standard care and changes in troponin assay methods. Hunt and Hess grades were assessed by the neurosurgery team and are subject to inter-rater variability. Pre-hospital symptoms such as unresponsiveness and seizures were obtained retrospectively from patient or family reports, which may be inaccurate or incomplete. The study population was predominantly Caucasian and female, which may limit the generalizability of the findings to other demographic groups.
Declared interests
The study was funded by grants R01HL074316 and R01NR014221.
The easy way to misread this
Do not assume that a prolonged QT interval or elevated troponin in these patients indicates a primary heart attack. The study found that none of the patients with myocardial injury had ECG changes consistent with ischemia, confirming the injury was neurogenic and secondary to the brain bleed.