acute cva

1. "A PROSPECTIVE STUDY OF ELECTROCARDIOGRAPHIC CHANGES IN ACUTE
CEREBROVASCULAR ACCIDENTS ."
TITLE

2. INTRODUCTION AND BACK GROUND
Cerebrovascular disease include some of most common disorder ischemic
stroke , hemorrhagic stroke, cerebrovascular anomalies.
Cardiac abnormalities occurs 60-70% patients after stroke most common
disturbance include ECG abnormality.
Cardiac disturbances are most common cause of death in stroke accounting for
upto 6 % unexpected deaths during first month.
The medulla has been described as the principle site at vagal parasympathetic
and sympathetic area involving cardiac arrest

3. AIM AND OBJECTIVES
To study the incidence and pattern of ECG changes in patient with cerebrovascular
accidents.
To assess the relation of ECG changes in acute cerebrovasular accident to the
location of cerebral lesion.
OBJECTIVES
AIM
To study the association of ECG changes with electrolytes abnormalities.
To know the incidence of rhythm disturbances in study group.

4. RESEARCH QUESTION
What are the electrocardiographic changes in acute cerebrovascular accidences ?

5. INCLUSION CRITERIA
All patients with acute cerebrovascular accidents.
EXLUSION CRITERIA
Patients with underlying heart diseases.
Patients on drugs like antidepressant , antipsychotics etc.
Previously diagnosed patients with electrolyte abnormalities
Patient with hepatic or renal diseases.

6. MATERIAL AND METHODS
STUDY SITE :
STUDY POPULATION : 50 acute cerebrovascular accident patients admitted .
DURATION OF SYUDY : 2 Years from 1st December 2020 to 30th November 2022.
STUDY DESIGN : OBSERVATIONAL AND PROSPECTIVE STUDY.

7. METHODOLOGY
After taking informed and written consent and after institutional and ethical committee
approval all included eligible patients will be subjected to a detailed clinical history and clinical
examinations and lab investigation as per proforma will be performed .
All patients with acute cerebrovascular accidents were studied.
They were assessed with serum electrolytes, X ray and blood urea and sugar 12 lead ECG was
taken and monitored on the day of admission.
CT scan was taken within 24-48 hrs.
Screening ECHO was done on all patients with ECG changes.

8. Patients previously diagnosed to have electrolyte abnormalities were also
excluded from the study.
Patients were categorized based on the CT finding as cerebral infarction,
cerebral hemorrhage and sub- arachnoid hemorrhage.
ECG was then interpreted with rate, rhythm, ST segment, QRS complex, T
wave amplitude and morphology and QT interval was calculated.
QTC interval was calculated based on Bazett formulae.

9. CINICAL CASE PROFORMA
NAME :
AGE :
SEX:
OCCUPATION :
RESIDENTIAL ADDRESS :
HISTORY
ONSET OF WEAKNESS:
PREVIOUS H/O OF CARDIAC DRUGS:
PREVIOUS H/O OF ELECTROLYTE ABNORMALITIES:
H/O LIVER DISEASES:
DATE:
IP NUMBER:

10. GENERAL EXAMINATION
CNS EXAMINATION
INVESTIGATION
URINE ROUTINE
BLOOD UREA
BLOODSUGAR
Sr CREATINE,
ELECTROLYTES
ECG
CT-BRAIN
2D ECHO

11. .
PREVIOUS STUDIES
1) BURCH AND COLLEAGUES described abnormal T waves
prominent U waves long QTC interval in patients with CVA
2)CROP MANNING analysed ECG in 29 patients with SAH flat or
negative T wave were noted in 15 patients , prolonged in QTC 14,
ischemic ST segment in 11 patients
3) SCHUSTER had observed QTC and bradycardia as characteritic of
SAH

12. 4) FRENTZ AND GORSMEN observed depression of ST segment is
the most common abnormality in 11 out of 15 patients with ICH
5)MILLER AND ABILDSKOV Most of 50 patients had non specific ST-T
wave abnormalities they observed high incidence of notched T waves .
6)BURCH,MAYER,ABILDSKOV found 10 abnormal ECG in patient with
CVA admitted to manning hospital

13. REFERENCES
1Goldstein DS : The electrocardiogram in stroke : relationship to pathophysiological type and comparison
with prior tracings. Stroke 10:253, 1979.
2.Tung P, Kopelnik A, Banki N, et al: predictors of Neurocardigenic injury after subarachnoid hemorrhage.
Stroke 35:548, 2004
3.Burch Ge, Myers R, Abildskov: A new electrographic pattern, observed in cerebrovascular accidents.
circulation9;719, 1954
4. Cropp GJ Manning GW;Electrographic changes simulating ischemia and infarction associated spontaneous
intracranial hemorrhages, Circulation25;22, 1962
5. Schuster-ECG in subarachnoid hemorrhage. British Heart journal22;316, 1960
6. Frentz v, GormsenJ;Electrocardiographic pattern with cerebrovascular accidents, circulation 25;22, 1962
7.Miller and Abildskov, Angiology vol, 22, no, 11, 616-621
8. Litchen and Schaub, Angiology vol, 22, no11, 616-621

14. PARTICIPANT INFORMATION SHEET :
You are invited to be a part of study
“……………………………………………………” Your participation in this study is
entirely voluntary.
The study period for 2 Years.
The identity of those participating in the study will not be shared with
anyone. It will be kept confidential. If you do not wish to continue, you are
free to withdraw from the study at any time. Your treatment at the
hospital will not be affected in any way

15. INFORMED CONSENT FORM : I have read the above information. I consent voluntarily to participate
as participant in this research.
Name of the participant ________________________
Signature of the participant ________________________
Date ________________________
If illiterate I have witnessed the accurate reading of the consent form to the potential participant. I
confirm that the individual has given consent freely. Name of the witness __________________ and
thumb print of participant
Signature of the witness ___________________
Date __________________
Statement by the researcher/person taking consent I confirm that the participant was given an
opportunity to ask questions about the study, and all the questions have been answered correctly
and to the best of my ability.
I confirm that the individual has not been forced into giving consent and the consent has been given
freely and voluntarily.
Name of the researcher/person taking the consent _________________________ Signature of the
researcher/person taking the consent _________________________ Date _________________
Contact number of researcher

16. సమ్మ తిపత్రము
ఇన్ఫ ర్మమ షన్షీట్
మీరు అధ్య యన్ం యొక్క ఒక్ భాగం గా ఆహ్వా నంచబడ్డ
ా రు. “………………………………………………………………………………….” ఈ అధ్య యన్ంలో మీ పాల్గ
ొన్డం పూర్తిగా సా చఛ ంద ఉంది.
అధ్య యన్ంలో పాలుపంచుకున్న వార్త గుర్తింపు ఎవర్తతో చెపప బడదు. ఇది రహసయ ంగా ఉంచబడుతంది. మీరు ఉపసంహర్తంచు కోవలనుకుంటే ఏసమ్యంలోన్యినా స్వా చఛ గా
మీరుఅధ్య యన్ం నుండి ఉపసంహర్తంచుకోవచుు . ఆసుపత్తిలో మీచికిరస ఏవిధ్ంగా త్పభావిరం కాదు.
సమ్మ తి సర్తిఫికెట్
నేను పై సమాచారానన చదివి. నేను ఈపర్తశోధ్న్లోభాగస్వా మినపాల్గ
ొ నేందుకుసా చఛ ందంగాసమ్మ తిసుినాన రు.
పాల్గ
ొ నేవార్తపేరు________________________
పాల్గ
ొ నేవార్త సంరక్ం ________________________
తేదీ __________________
నరక్షరాసుయ లైన్ఉంటే
నేను సంభావయ పాల్గ
ొ నే అనుమ్తిరూపం యొక్క ఖచిు రమైన్పఠన్ం చేయడాంచూస్వను. నేను వయ కి ి
గరస్వా చఛ గా అనుమ్తిఇచిు ంది అననరాా ర్తస్తు
సుినాను.
పాల్గ
ొ నేవార్తపేరు________________________ మ్ర్తయు పాల్గ
ొ నేవార్త వేలిముత్ద
పాల్గ
ొ నే వార్తసంరక్ం ________________________
తేదీ __________________
పర్తశోధ్కుడు / వయ కి ి
తీసుకొనఅంగీకారంతోత్పక్టన్
నేను పాల్గ
ొ నే అధ్య యన్ం గుర్తంచి త్పశ్న ంచేందుకు అవకాశం ఇవా బడింది, మ్ర్తయుఅనన త్పశన లకుసర్తగాొమ్ర్తయునాస్వమ్ర్య ంమేరకుసమాధాన్ంఇవా బడింది..
నేనువయ కి ి
గరసమ్మ తిఇవా డంలోకిఎవర్తనబలవంరంచేయలేదుమ్ర్తయుసమ్మ తిస్వా చఛ గా మ్ర్తయు సా చఛ ందంగాఇవా బడింది.
అనుమ్తితీసుకొనపర్తశోధ్కుడు / వయ కి ి
యొక్క పేరు ___________________________
అనుమ్తితీసుకొనపర్తశోధ్కుడు / వయ కి ి
యొక్క సంరక్ం _________________________
తేదీ ______________________

17. THANK YOU