Electrocardiographic Alterations in Patients with Acute Cerebral Hemorrhage: A Case Series and Implications for Critical Care Nursing

Abstract

Introduction. Acute cerebral hemorrhages may be associated with secondary cardiovascular manifestations, including electrocardiographic abnormalities, even in the absence of pre-existing structural heart disease. In the intensive care setting, the early recognition of these abnormalities may have both clinical and nursing relevance. Methods. A single-center observational case series was conducted at the Intensive Care Unit of the ARNAS “G. Brotzu” Hospital in Cagliari, Italy. Twenty-five patients admitted between July and October 2025 with a diagnosis of acute cerebral hemorrhage, including subarachnoid hemorrhage, intracerebral hemorrhage, and subdural hematoma, were included. ECG abnormalities observed during the first 5 days of hospitalization and their clinical and nursing significance were analyzed. Results. Electrocardiographic abnormalities were observed in 15 of 25 patients (60.0%). Among patients with ECG abnormalities, 9 (60.0%) presented isolated QTc prolongation, 3 (20.0%) showed isolated T-wave abnormalities, and 3 (20.0%) exhibited both findings. No clinically significant ST-segment changes or rhythm disturbances were detected. Pupillary abnormalities and hypertension were observed in 36.0% and 32.0% of patients, respectively. Conclusions. In this case series, ECG abnormalities, particularly QTc prolongation, were frequent in patients admitted to the intensive care unit for acute cerebral hemorrhage. When integrated with neurological and hemodynamic assessment, ECG monitoring may represent a useful tool for the early recognition of complications and for planning targeted nursing interventions in neurocritical patients.