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December 1, 1975

Brain and Heart— The Autonomic Connection

JAMA. 1975;234(9):959. doi:10.1001/jama.1975.03260220063024

When we indicate the brain in accounting for a cardiac disorder, we usually do so in the context of psychosomatic medicine. We recognize that, triggered by emotion, impulses from the brain may derange the rate or the rhythm of the heart through the mediation of the autonomic nervous system. What is not so well appreciated is that organic brain damage, as in intracranial hemorrhage, can also affect the heart. And what is even less well recognized is that it may do so frequently and with serious consequences.

Nearly thirty years ago, Byer et al1 reported tall, upright T waves and prolonged QT intervals in a patient with subarachnoid hemorrhage. In 1954, Burch and associates2 described a similar pattern, but with frequently inverted T waves and large U waves in patients with cerebrovascular accidents. Since then, a number of other reports have related various ischemic and arrhythmic electrocardiographic findings