Transient Cardiac Dysfunction in Cerebrovascular Accidents

Abstract

Acute cerebral injuries have been repeatedly correlated with sudden and different electrocardiogram (EKG) changes, such as cardiac arrhythmias, QT prolongation, and abnormal T-wave morphology. One rare phenomenon is "cerebral T-waves," which are T-waves observed in the context of stroke and described as transient, symmetric, and deeply inverted. Moreover, few studies linked acute cerebral injuries with transient cardiac dysfunction secondary to autonomic dysfunction. The classic cerebral T-waves are defined as a T-wave inversion of ≥5 mm depth in ≥4 contiguous precordial leads, and it is more commonly observed in the setting of acute ischemic stroke rather than hemorrhagic stroke. We present a patient who presented with acute pulmonary edema, T-wave inversions in the precordial leads, and left ventricular (LV) dysfunction initially suspicious for acute coronary syndrome (ACS). However, computer tomography of the brain performed on the third day of his hospital stay proved us wrong.

Keywords: acute cerebrovascular accidents; cerebral t waves; left ventricular systolic dysfunction.

Figure 1. EKG showing T-wave inversions over the precordial leads (black arrows).

Figure 2. CT scan on the third day of admission showing large evolving infarct within left temporal/left parietal lobe (yellow arrow).

Figure 3. EKG showing the resolution of the T-wave inversions on the third day of hospital stay (black arrow).