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Critical Care Cardiology: Claire E. Sommargren Electrocardiographic Abnormalities in Patients With Subarachnoid Hemorrhage Am J Crit Care 2002; 11: 48-56 [Abstract] [Full text] [PDF]

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Subarachnoid Hemorrhage Presenting As Supraventricular Tachycardia

Sanjay Bhandari, Dr Pinakin Gujjar   (18 January 2008)

Subarachnoid Hemorrhage Presenting As Supraventricular Tachycardia 18 January 2008
Sanjay Bhandari, Third-year resident, anesthesiology KEM Hospital, Mumbai, Dr Pinakin Gujjar Send letter to journal: Re: Subarachnoid Hemorrhage Presenting As Supraventricular Tachycardia sanjaybhandari80{at}gmail.com Sanjay Bhandari, et al.	We have had an experience with arrhythmias occurring with subarachnoid hemorrhage (SAH). A 35-year-old woman who had developed SAH was posted for aneurysm clipping. She was hemodynamically stable with no neurological deficits. Her past medical history was insignificant. On the table before induction of anesthesia, the hemodynamics were normal and the ECG showed normal sinus rhythm with a rate of 86/min. The patient was induced and intubated with standard protocols. Lignocaine (lidocaine) 1.5mg/kg was given to avoid the stress response during laryngoscopy and intubation. Five minutes after intubation, an ECG showed supraventricular tachycardia with a rate of 190/min. It was reverted with 0.25 mg/kg diltiazem. After stabilization, the patient was evaluated. As the patient was totally anesthetized, her neurological status was difficult to assess. Examination of pupils revealed that they were fixed and dilated. A presurgical CT scan revealed a rebleed in the subarachnoid space. Our experience with this incident has prompted us to think that any arrhythmia in a patient undergoing aneurysmal clipping could be due to rebleeding. FINANCIAL DISCLOSURES None reported.