Nörolojik Hastalıklarda EKG Değişiklikleri
Özet
Elektrokardiyografi (EKG), sadece kardiyolojik durumların değil, aynı zamanda çeşitli nörolojik hastalıkların tanı ve takibinde de önemli bir araçtır. Merkezi ve periferal sinir sistemi hastalıkları, kalbin otonom kontrolünü etkileyerek belirgin EKG değişikliklerine yol açabilir. En yaygın gözlenen EKG değişiklikleri QT-interval uzaması, ST-segment değişiklikleri ve T dalgası anormallikleridir. Bu bölümde travmatik beyin yaralanmaları, inme, subaraknoid kanama, epilepsi, Guillain-Barré sendromu, Parkinson hastalığı gibi nörolojik bozukluklarla ilişkilendirilen EKG değişiklikleri ele alınacak; bu değişikliklerin klinik anlamı, patofizyolojik mekanizmaları ve yönetim stratejileri incelenecektir. Bu bilgiler nörolojik hastalıklarda kardiyak riskleri daha iyi anlamayı, yalnızca kardiyak riskleri değil aynı zamanda beyindeki hasarın şiddeti, yaygınlığını belirleme ve hasta yönetimini iyileştirmeyi amaçlamaktadır.
Referanslar
Ramani A, Shetty U, Kundaje GN. Electrocardiographic Abnormalities in Cerebrovascular Accidents. Angiology. 1990;41(9):681-686. doi:10.1177/000331979004100902
Christensen H, Christensen AF, Boysen G. Abnormalities on ECG and telemetry predict stroke outcome at 3 months. J Neurol Sci. (2005) 234:99–103. doi: 10.1016/j.jns.2005.03.039
Chen Z, Venkat P, Seyfried D. Brain-heart interaction: cardiac complications after stroke. Circ Res. (2017) 121:451–68. doi: 10.1161/CIRCRESAHA.117.311170
Lenstra JJ, Kuznecova-Keppel Hesselink L, la Bastide-van Gemert S, Jacobs B, Nijsten MWN, van der Horst ICC, van der Naalt J. The Association of Early Electrocardiographic Abnormalities With Brain Injury Severity and Outcome in Severe Traumatic Brain Injury. Front Neurol. 2021 Jan 8;11:597737. doi: 10.3389/fneur.2020.597737.
Longhitano Y, Bottinelli M, Pappalardo F, Maj G, Audo A, Srejic U, Rasulo FA, Zanza C. Electrocardiogram alterations in non-traumatic brain injury: a systematic review. J Clin Monit Comput. 2024 Apr;38(2):407-414. doi: 10.1007/s10877-023-01075-5
Sommargren CE. Electrocardiographic abnormalities in patients with subarachnoid hemorrhage. Am J Crit Care. (2002) 11:48–56. doi: 10.4037/ajcc2002.11.1.48
Sommargren CE, Zaroff JG, Banki N, Drew BJ. Electrocardiographic repolarization abnormalities in subarachnoid hemorrhage. J Electrocardiol. (2002) 35:257–62. doi: 10.1054/jelc.2002.37187
Kono T, Morita H, Kuroiwa T, Onaka H, Takatsuka H, Fujiwara A. Left ventricular wall motion abnormalities in patients with subarachnoid hemorrhage: neurogenic stunned myocardium. J Am Coll Cardiol. (1994) 24:636–40. doi: 10.1016/0735-1097(94)90008-6
van Bree MDR, Roos YBWEM, van der Bilt IA C, Wilde AAM, Sprengers MES, de Gans K, et al. Prevalence and characterization of ECG abnormalities after intracerebral hemorrhage. Neurocrit Care. (2010) 12:50–5. doi: 10.1007/s12028-009- 9283-z
Frontera JA, Parra A, Shimbo D, et al. Cardiac arrhythmias after subarachnoid hemorrhage: risk factors and impact on outcome. Chest. 2008;133(5):1267-1274. doi:10.1378/chest.07-2562
Oppenheimer S. Cerebrogenic cardiac arrhythmias: cortical lateralization and clinical significance. Clin Auton Res. (2006) 16:6–11. doi: 10.1007/s10286-006-0276-0
Schuiling WJ, Algra A, de Weerd AW, Leemans P, Rinkel GJ. ECG abnormalities in predicting secondary cerebral ischemia after subarachnoid haemorrhage. Acta Neurochir (Wien). 2006 Aug;148(8):853-8; discussion 858. doi: 10.1007/s00701-006-0808-3.
van der Lende M, Surges R, Sander JW, Thijs RD. Cardiac arrhythmias during or after epileptic seizures. J Neurol Neurosurg Psychiatry. 2016 Jan;87(1):69-74. doi: 10.1136/jnnp-2015-310559.
Sevcencu C, Struijk JJ. Autonomic alterations and cardiac changes in epilepsy. Epilepsia. 2010 May;51(5):725-37. doi: 10.1111/j.1528-1167.2009.02479.x.
Zijlmans M, Flanagan D, Gotman J. Heart rate changes and ECG abnormalities during epileptic seizures: prevalence and definition of an objective clinical sign. Epilepsia. 2002 Aug;43(8):847-54. doi: 10.1046/j.1528-1157.2002.37801
Lee S, Gong M, Lai RWC, Liu FZ, Lam MHS, Chang D, Xia Y, Liu T, Tse G, Li KHC. Electrographic indices in migraine patients: A systematic review and meta-analysis. J Electrocardiol. 2019 Nov-Dec;57:63-68. doi: 10.1016/j.jelectrocard.2019.05.018.
Surawicz B, Knoebel SB. Long QT: good, bad or indifferent? J Am Coll Cardiol. 1984 Aug;4(2):398-413. doi: 10.1016/s0735-1097(84)80232-6.
Magnano AR, Holleran S, Ramakrishnan R, Reiffel JA, Bloomfield DM. Autonomic nervous system influences on QT interval in normal subjects. J Am Coll Cardiol. 2002 Jun 5;39(11):1820-6. doi: 10.1016/s0735-1097(02)01852-1.
Darbar D, Fromm MF, Dellorto S, Roden DM. Sympathetic activation enhances QT prolongation by quinidine. J Cardiovasc Electrophysiol. 2001 Jan;12(1):9-14. doi: 10.1046/j.1540-8167.2001.00009.x.
Gotoh F, Komatsumoto S, Araki N, Gomi S. Noradrenergic nervous activity in migraine. Arch Neurol. 1984 Sep;41(9):951-5. doi: 10.1001/archneur.1984.04050200057018.
Boccuni M, Alessandri M, Fusco BM, Cangi F. The pressor hyperresponsiveness to phenylephrine unmasks sympathetic hypofunction in migraine. Cephalalgia. 1989 Dec;9(4):239-45. doi: 10.1046/j.1468-2982.1989.0904239.x.
Pfeiffer G. Dysautonomie bei Guillain-Barré-Syndrom [Dysautonomia in Guillain-Barré syndrome]. Nervenarzt. 1999 Feb;70(2):136-48. German. doi: 10.1007/s001150050414.
Kincl V, Panovský R, Bočková M, Rektor I, Mojica-Pisciotti ML, Máchal J. Parkinson´s disease cardiovascular symptoms: A new complex functional and structural insight. Eur J Neurol. 2024 Feb;31(2):e16110. doi: 10.1111/ene.16110.
Akbilgic O, Kamaleswaran R, Mohammed A, Ross GW, Masaki K, Petrovitch H, Tanner CM, Davis RL, Goldman SM. Electrocardiographic changes predate Parkinson's disease onset. Sci Rep. 2020 Jul 9;10(1):11319. doi: 10.1038/s41598-020-68241-6.
Mochizuki H, Ebihara Y, Ugawa Y, et al. PR prolongation and cardiac 123I-MIBG uptake reduction in Parkinson’s disease. Eur Neurol. 2015;74:107–111. doi:10.1159/000439022
Malkiewicz JJ, Malkiewicz M, Siuda J. Prevalence of QTc Prolongation in Patients with Parkinson’s Disease. Assessment of the Effects of Drugs, Clinical Risk Factors and Used Correction Formula. Journal of Clinical Medicine. 2021; 10(7):1396. https://doi.org/10.3390/jcm10071396
Zhong LL, Song YQ, Ju KJ, Chen AN, Cao H. Electrocardiogram Characteristics of Different Motor Types of Parkinson's Disease. Int J Gen Med. 2021 Mar 25;14:1057-1061. doi: 10.2147/IJGM.S296769.
Malek NM, Grosset KA, Stewart D, Macphee GJ, Grosset DG. Prescription of drugs with potential adverse effects on cardiac conduction in Parkinson's disease. Parkinsonism Relat Disord. 2013 Jun;19(6):586-9. doi: 10.1016/j.parkreldis.2013.02.004.
Rudehill A, Olsson GL, Sundqvist K, Gordon E. ECG abnormalities in patients with subarachnoid haemorrhage and intracranial tumours. J Neurol Neurosurg Psychiatry. 1987 Oct;50(10):1375-81. doi: 10.1136/jnnp.50.10.1375.
Sethuraman M, Hrishi AP, Prathapadas U, Ajayan N. Electrocardiographic changes in patients with raised intracranial pressure from supratentorial brain tumors. J Neurosci Rural Pract. 2023 Jan-Mar;14(1):55-61. doi: 10.25259/JNRP-2022-2-23.
Koepp M, Kern A, Schmidt D. Electrocardiographic changes in patients with brain tumors. Arch Neurol. 1995 Feb;52(2):152-5. doi: 10.1001/archneur.1995.00540260056016.
