Cerebral Mime of Ischæmia

Report:

Sinus rhythm 54/min

LVH voltage, probably normal for age

ST/T changes suggestive of ischaemia

Prolonged QTc 0.47” (QT 0.5”)

Comment:

An accident may cause both cardiac and cerebral damage, often with marked ECG changes. On the other hand, both heart and brain are, obviously, potential causes of the accident in the first place. Causality, at times, may be surprisingly difficult to establish.

In this case, the injuries were confined to the head and the heart was echocardiographically normal. There was slight troponin rise and the ECG changes to attest to, if anything, severity of the cerebral injury. The only ECG clue that the changes are secondary to CNS causes is the prolonged QT interval. Even that was not present in the admission trace (Fig 74a), taken four hours previously, with bradycardia 45/min.

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