The Clinical Analysis Of 89 Patients With Cerebro-cardiac Syndrome

The patient with acute cerebrovascular disease always presentscardiac injury which is called cerebro-cardiac syndrome (CCS)through clinical observation. It characterizes as the abnormal of ECG,arrhythmia, elevation of cardiac enzyme and so on,and it mayinfluence the prognosis of the patient and increase the risk of suddendeath. So clinical doctors should pay more attention to it to avoidmisdiagnosis or miss diagnosis. But the mechanism of CCS is not wellunderstood yet. Its diagnosis is mainly based on ECG which have highsensitivity but low specificity. There is not any special drug for thetreat of CCS but mainly based on the treatment of primary cerebraldisease. Objective and Methods: In order to study the mechanism ofCCS,clinical manifestation,diagnosis,therapy and the impact on theprognosis, raise the attention of doctors to it and build the basis for theclinic. A series of 146 patients consecutively admitted to our hospitalbetween July 2005 to September 2005 with the diagnosis of acutecerebrovascular disease were studied. Carry through clinical analysefrom the occur time of CCS, the relationship with the type of acutecerebrovascular disease,if break into ventricle,the position of acutecerebrovascular disease,disturdance confusion,lever of FBG, and theimpact on the prognosis. Result: ⑴ 78 cases (87.64%) in 89 cases occur CCS within 72hours after acute cerebrovascular disease, 9 cases (10.11%) occurCCS within 72 hours to 1 week. ⑵ There are one or more ECGchanges in one case,include myocardial ischemia,arrhythmia,pseudo-myocardial infarction and acute myocardial infarction. In ourstudy, 56 cases occur myocardal ischemia (62.92%) in 89 CCS cases,include 52 cases of ST-T changes,6 cases of prolonged QT,3 casesof U waves;42 cases of arrhythmia (47.19%), include 14 cases ofsinus tachycardia,11 cases of sinus bradycardia, 4 cases of prematureatrial contraction, 2 cases of premature ventricular contraction, 7 casesof block, 6 cases of atrial fibrillation;9 cases of pseudo-myocardialinfarction (10.11%),present ST elevation, T wave inversion;3 casesof acute myocardial infarction (3.37%) , present ST arch likedelevation, T wave inversion, pathologic Q wave. ⑶ There are 89 casesoccur CCS in 146 cases with acute cerebrovascular disease in ourstudy (60.96%), the morbidity of CI is 44.26%, the morbidity of ICHis 74.14%,and the morbidity of SAH is 70.37%,latter two is obvioushigher than former, statistics difference is present. And the rate ofbreak into ventricle for ICH (19/23) is higher than not break intoventricle (24/35). ⑷ The ECG changes of 27 CI cases with CCS are12 myocardial ischemia, 19 arrhythmia, 3 pseudo-myocardial infarct-tion and 1 acute myocardial infarction;43 ICH cases with CCS have30 myocardial ischemia, 17 arrhythmia, 5 pseudo-myocardialinfarction and 2 acute myocardial infarction;19 SAH cases of CCShave 14 myocardial ischemia, 6 arrhythmia, 1 pseudo-myocardialinfarction and no acute myocardial infarction. About the type ofelectro-cardiogram change, prolonged QT and U waves are commonin ICH,SAH. Premature contraction and atrial fibrillation are commonin CI. ⑸ The morbidity of CCS in thalamencephalon,basal ganglia,brainstem,cerebellum and lobar are 71.43%,67.35%,72.73%,62.50%,36.67%. The rate of thalamencephalon,basal ganglia,brainstem,cerebellum are higher than lobar. The cases of lobar weredivided into left lobar and right lobar. The morbidity of left side andright side are 49.12% (28/57),72.09% (31/43). Arrhythmia is commonin lobar lesion, and 35.56% (16/43) is right side,18.64% (11/57) is leftside, there are 4 on right and 2 on left for sinus tachycardia, 2 on rightand 5 on left for sinus bradycardia. ⑹ there are 19 cases died in 89cases with CCS. The type of them are 14 ICH, 3 CI and 2 SAH. Theposition of them are 6 thalamencephalon , 3 basal ganglia , 2brainstem,2 cerebellum and 5 lobar. The ECG changes of them are 9ST-T change, 4 prolonged QT, 2 U wave, 8 sinus tachycardia, 5 sinusbradycardia, 4 pseudo-myocardial infarction, 3 acute myocardialinfarction. ⑺The morbidity of cases with disturdance confusion andno disturdance confusion group are 54.64% (53/97),73.47% (36/49)。⑻FBG: the CCS group is 7.68±2.19 mmol/L, the normal group is6.05±1.85 mmol/L,there are obvious statistics difference between thetwo groups. ⑼There are only 16 cases in 89 cases with CCS feeluncomfortable of heart area,palpitation,tightness,breathe hard,anxiety and so on . 2 cases of acute myocardial infarction feel obviouspain of heart area. ⑽ The resume of nerve function for CCS group areworse than normal group, and mortality is higher.Conclusion:⑴CCS usually occur within 1 week after acute cerebrovasculardisease.⑵The ECG changes include myocardial ischemia,arrhythmia,pseudo-myocardial infarction and acute myocardial infarction.Myocardial ischemia is the most frequently appearance, after it arearrhythmia , pseudo-myocardial infarction and acute myocardialinfarction by frequency. Prolonged QT and U wave maybe are thecharacteristic expressions.⑶The morbidity of CCS in ICH,SAH are higher than CI,and itin patient of breaking into ventricle is higher than the patient withoutbreaking into ventricle. ECG of ICH,SAH often present ProlongedQT,U wave and ST-T changes,and ECG of CI often presentpremature contraction and atrial fibrillation.⑷The occurrence of CCS was apt to the patient accompany withdisturdance confusion and high FBG.⑸As the position of disease is closer to midline, the morbidity ofCCS is higher, and the presentation is more obvious. The arrhythmiais common in the patient of lobar lesion, and the morbidity of rightside is higher than the left side.⑹The patient of ICH,have ECG changes like Prolonged QT andU wave and the position of disease is closer to midline will have ahigher mortality.⑺The resume of nerve function for patient with CCS is slowerthan normal , and the morbidity is higher. The patient with stroke whopresent abnormal ECG may predict the severity of the disease. Theserious one maybe have sudden death subsequently. So ECG wardshould be used in the patients with CCS especially for those whopresent ventricular repolarization changes.⑻ECG is an important index for the diagnosis of CCS, it hashigh sensitivity but low specificity. So continuous or frequent ECGward is required.