Cardiac Care in Critically Ill Neurological Patients

  • Johannes Brachmann
  • Laurie Moore
  • Hans Peter Schuster
  • Daniel F. Hanley


The upper limits of normal for systolic and diastolic blood pressures are 140 and 90 mmHg, respectively. Repeated measured values above 150 mmHg systolic or 90 mmHg diastolic must be considered hypertension. Chronic hypertension is implicated in ischemic heart disease, atherosclerotic vascular disease, renal failure, and stroke. Although the most common form of hypertension, essential hypertension, is of unknown etiology, secondary causes of hypertension include renal and renovascular disease, endocrine disorders (Cushing’s syndrome, Conn’s syndrome, pheochromocytoma, or carcinoid), obesity, and pregnancy. A thorough evaluation of hypertensive patients is indicated. An overview is given in Table 1.


Hypertensive Crisis Sick Sinus Syndrome Restrictive Cardiomyopathy Hypertensive Encephalopathy Familial Dysautonomia 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Suggested Reading

  1. Braunwald E et al. (eds) (1987) Harrison’s principles of internal medicine, 11th edn. McGraw-Hill, New YorkGoogle Scholar
  2. Burch GE, Myers R, Abildskev JA (1954) A new electrocardiographic pattern observed in cerebrovascular accidents. Circulation 9: 719–723PubMedGoogle Scholar
  3. Carruth JE, Silverman ME (1980) Torsade de point: atypical ventricular tachycardia complicating subarachnoid hemorrhage. Chest 78: 886–888PubMedCrossRefGoogle Scholar
  4. CAST Investigators (1989) Preliminary report — effect of encainide and flecainide on mortality in a randomized trial of arrhythmia suppression after myocardial infarction. N Engl J Med 321: 406–412CrossRefGoogle Scholar
  5. Ciraulo D, Lind L, Salzman C et al. (1978) Sodium nitroprusside treatment of ECTinduced blood pressure elevations. Am J Psychiatry 135: 1105PubMedGoogle Scholar
  6. Deutsche Liga zur Bekämpfung des hohen Blutdruckes e V (1992) Empfehlung zur Hochdruckbehandlung in der Praxis und zur Behandlung hypertensiver Notfälle, 10th edn. Heidelberg, pp 5–6Google Scholar
  7. Estanol BV, Marin OSM (1975) Cardiac arrhythmias and sudden death in subarachnoid hemorrhage. Stroke 6: 382–386PubMedCrossRefGoogle Scholar
  8. Fromer M, Brachmann J, Block M, Siebels J, Hoffmann E, Almendral J, Ohm OJ, den Dulk K, Coumel P, Camm J, Touboul P (1992) Efficacy of automatic multimodal device therapy for ventricular tachyarrhythmias as delivered by a new implantable pacing cardioverter defibrillator. Circulation 86: 363–374PubMedGoogle Scholar
  9. Hall, Schmidt, Wood (1992) Principles of critical care. McGraw-Hill, New YorkGoogle Scholar
  10. Hammer WJ, Lussenhop AJ, Weintraub AM (1975) Observations on the electrocardiographic changes associated with subarachnoid hemorrhage with special reference to their genesis. Am J Cardiol 59: 427–433Google Scholar
  11. Hersch C (1961) Electrocardiographic changes in head injuries. Circulation 23: 853–860PubMedGoogle Scholar
  12. Hugenholtz PG (1962) Electrocardiographic abnormalities in cerebral disorders. Report of six cases and review of the literature. Am Heart J 63: 451–461PubMedCrossRefGoogle Scholar
  13. Kaplan NM (1986) Clinical hypertension, 4th edn. Williams and Wilkins, BaltimoreGoogle Scholar
  14. Kupersmith J (1993) Long QT syndrome. In: Singer I, Kupersmith J (eds) Clinical manual of electrophysiology. Williams and Wilkins, Baltimore, pp 156–158Google Scholar
  15. Lee YC, Sutton FJ (1984) Concomitant pulses and U wave alternans associated with head trauma. Am J Cardiol 55: 851–852CrossRefGoogle Scholar
  16. Liberatore MA, Robinson DS (1984) Torsades de pointes: a mechanism for sudden death associated with neuroleptic drug therapy? J Clin Psychopharmacol 4 (3): 143–146PubMedCrossRefGoogle Scholar
  17. Lown B, Wolff M (1971) Approaches to sudden deaths from coronary heart disease. Circulation 44: 130–142PubMedGoogle Scholar
  18. Marion DW, Segai R, Thompson ME (1986) Subarachnoid hemorrhage and the heart. Neurosurgery 18 (1): 101–106PubMedCrossRefGoogle Scholar
  19. Naftchi NE Tuckman (1989) Hypertensive crises in spinal man. Am Heart J 97: 537Google Scholar
  20. Rettig G, Stober T, Sen S (1986) Disorders of the central nervous system and cardiac arrhythmias. Z Kardiol 75 [Suppl 5]: 57–64PubMedGoogle Scholar
  21. Sen S, Stober T, Burger L et al. (1984) Recurrent torsades de pointes-type ventricular tachycardia in intracranial hemorrhage. Intensive Care Med 10: 263–2643PubMedCrossRefGoogle Scholar
  22. Shoemaker WC, Ayres S, Grenvik A, Holbrook PR, Thompson WL (1989) Textbook of critical care. Saunders, PhiladelphiaGoogle Scholar
  23. Task Force of the Working Group on arrhythmias of the European Society of Cardiology (1997) The Sicilian gambit. Eur Heart J 12: 1112–1131Google Scholar
  24. Thompson WL (1989) Hypertensive urgencies and emergencies. In: Shoemaker et al. (eds) Textbook of critical care, 2nd edn. Saunders, Philadelphia, pp 391–412Google Scholar
  25. Vaughan Williams EM (1984) A classification of antiarrhythmic action reassessed after a decade, of new drugs. J Clin Pharmacol 24: 129–147Google Scholar
  26. Wynne J, Braunwald E (1987) The cardiomyopathies and myocaritides. In: Braunwald E et al. (eds) Harrison’s principles of internal medicine, 11th edn. McGraw-Hill, New York, pp 998–1004Google Scholar
  27. Wynne J, Braunwald E (1992) The cardiomyopathies and myocardites: toxic, chemical, and physical damage to the heart. In: Braunwald E (ed) Heart disease. A textbook of cardiovascular medicine, 4th edn. Saunders, Philadelphia, pp 1394–1450Google Scholar
  28. Zipes DP (1992) Specific arrhythmias: diagnosis and treatment. In: Braunwald E (ed) Heart disease. A textbook of cardiovascular medicine, 4th edn. Saunders, Philadelphia, pp 628–666Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1994

Authors and Affiliations

  • Johannes Brachmann
  • Laurie Moore
  • Hans Peter Schuster
  • Daniel F. Hanley

There are no affiliations available

Personalised recommendations