Electrocardiographic Changes after General Anaesthesia Induction in a Patient with Subarachnoid Haemorrhage and Thyroid Heart Disease: A Case Report

Dewa NGD Sanjaya; Padma Permana; Agung BS Satyarsa; Dewa PW Wardhana

doi:10.28932/jmh.v7i2.11506

Authors

Dewa NGD Sanjaya Department of Anaesthesiology and Intensive Care, Bangli General Hospital, Bali, Indonesia
Padma Permana General Practitioner, Bangli General Hospital, Bali, Indonesia
Agung BS Satyarsa Neurosurgery Division, Department of Surgery, Faculty of Medicine, Universitas Udayana, Bali, Indonesia
Dewa PW Wardhana 4Neurosurgery Division, Department of Surgery, Faculty of Medicine, Universitas Udayana

DOI:

https://doi.org/10.28932/jmh.v7i2.11506

Keywords:

atrial fibrillation, fentanyl, propofol, subarachnoid haemorrhage

Abstract

Electrocardiographic (ECG) abnormalities are commonly observed in patients with subarachnoid hemorrhage (SAH) and patients and are linked to worse outcomes. This case report documents the rapid normalization of severe ECG abnormalities following general anesthesia induction in a high-risk SAH patient with hyperthyroid heart disease. We report an 81-year-old woman with Fisher grade IV SAH and hyperthyroidism-associated cardiomyopathy who presented obtunded (GCS 7) with refractory atrial fibrillation at 116 bpm, diffuse T-wave inversions, and elevated troponin I. Following a multidisciplinary discussion, an External Ventricular Drain (EVD) was placed under general anesthesia using fentanyl, propofol, and rocuronium. This resulted in the immediate restoration of sinus rhythm, resolution of repolarization changes, and stabilization of blood pressure. Despite comprehensive ICU management—including analgesia, sedation, osmotherapy, steroids, and diuretics—the patient’s condition deteriorated within 24 hours, developing refractory intracranial hypertension and leading to death. This case highlights the autonomic-modulating and antiarrhythmic properties of anaesthetic agents in SAH-related neurocardiogenic dysfunction and underscores the need for further research into optimal anaesthesia strategies and patient outcomes.

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