Friday, June 21, 2013

ECG changes are more prominent in right-sided stroke lesions

Neurological events such as stroke or bleed can result in ECG changes include prolonged QTc predisposing to arrhythmias, T-wave changes, non-specific ST changes, Q waves.

These neurocardiac changes usually normalizes with brain death.

Why do these neurocardiac changes occur?
They are due to massive catecholamine release secondary to hypoperfusion of the posterior hypothalamus.

These ECG changes occur more commonly in right-sided stroke than in left-sided stroke.

This is due to lateralization of the autonomic innervation of the heart.

The parasympathetic and sympathetic innervation on the right side supplies mainly to the sinus node  and on the left side mainly to the atrioventricular node and the ventricles.

These central autonomic pathways to the heart descend uncrossed

Earlier animal studies have also shown that experimental stroke in the right hemisphere induced more pronounced sympathetic effects (e.g. sinus tachycardia) than lesions on the left side.

Furthermore, compared with left-sided stroke, right-sided stroke is associated with a reduced respiratory heart rate variability. Unfortunately, low heart rate variability may also be associated with an increased risk of sudden death even in patients without a history of cardiac infarction.

Naver HK, Blomstrand C, Wallin BG. Reduced Heart Rate Variability After Right-Sided Stroke. Stroke. 1996 February 1, 1996;27(2):247-51.
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