Atrial Natriuretic Factor and Electrocardiographic Abnormalities after Subarachnoid Hemorrhage

Park, Youn Kwan; Chung, Heung Seob; Lee, Ki Chan; Lee, Hoon Kap

Abstract

Atrial natriuretic factor(ANF) is a diuretic natriuretic peptide hormone produced by both the heart and brain. It has been postulated to play a role in the hemodynamic and sodium instability that frequently follows subaracthnoid hemorrhage(SAH). Electrocardiographic(EKG) abnormalities is known to occur frenquently after cerebrovascular accident, especially subarachnoid hemorrhage. A prospective study was undertaken to evaluate the relation between the changes of ANF and EKG findings and clinical findings. Thirty-five nonselected patients with SAH were followed with serial measurements of plasma ANF, plasma antidiuretic hormone(ADH), serum sodium, serum osmolarity, and electrocardiography(EKG) at 2nd, 5th, and 7th day after hemorrhage. Mean plasma ANF values at 2nd, 5th, and 7th day of hemorrhage were 202.3+/-109.6 pg/ml, 134.6+/-83.5 pg/ml, and 123.3+/-69.9 pg/ml, respectively. Mean plasma ADH values were within normal limits(3.2-4.4 pg/ml). At a later stage, 9 patients showed hyponatremia and hypoosmolarity, among whom 8 patients had elevated ANF and 1 patient elevated ADH. The delayed and persistent rise of plasma ANF was correlated with the development of hyponatremia. One or more EKG abnormalities were found in 13 patients. Mean ANF values of patients with normal EKG(131.8+/-48.7 pg/ml) were significantly different from those with abnormal EKG(272.2+/-107.5 pg/ml). The changes of plasma ANF appeared unrelated to age, sex, clinical grade, CT grade, and bleeding site. The results of this study indicate that elevated plasma ANF is closely related with electrophysiological changes of myocardium and that the transitory myocardial ischemia might be the source of plasma ANF sfter SAH.