DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20170179

Subarachnoid haemorrhage mimicking as myocardial infarction

Amanjeet S. Kindra, Abhimanyu Pandit, Suryanarayanan Bhaskar

Abstract


Electrocardiographic (ECG) changes due to subarachnoid haemorrhage (SAH) are seen frequently and mimic acute myocardial infarction. For appropriate therapeutic management it is very important to distinguish acute coronary syndrome from neurogenic myocardial injury, which is a reversible condition. A 35 year old male presented to us with history of acute chest pain, ECG suggestive of anterolateral myocardial infarction for which he underwent anticoagulant therapy. It was subsequently diagnosed to be a case of SAH due to ruptured anterior communicating artery aneurysm.

Keywords


ECG changes, Myocardial infarction, Subarchnoid haemorrhage

Full Text:

PDF

References


Van Gijn J, Ker RS, Rinkel GJ. Subarachnoid haemorrhage. Lancet. 2007;369(9558):306-18.

Linn FHH, Wijdicks EFM, Gijn J, Graaf YD, Bartelds AIM. Prospective study of sentinel headache in aneurysmal subarachnoid haemorrhage. Lancet. 1994;344(8922):590-3.

Polmear A. Sentinel headaches in aneurysmal subarachnoid haemorrhage: what is the true incidence? A systematic review. Cephalgia. 2003;23(10):935-41.

Davis TP, Alexander J, Lesch M. Electrocardiographic changes associated with acute cerebrovascular disease: a clinical review. Prog Cardiovasc Dis. 1993;36(3):245-60.

Inamsu J, Miyatake S, Tomioka H, Nakatsukasa M, Imai A, Kase K. Headache, cardiac arrest, and intracranial haemorrhage. J Headache Pain. 2009;10(5):357-60.

Byer VE, Ashman R, Toth LA. Electrocardiogram with large upright T wave and long Q-T intervals. Am Heart J. 1947;33:796-801.

Zaroff JG, Rordorf GA, Newell JB, Ogilvy CS, Levinson JR. Cardiac outcome in patients with subarachnoid hemorrhage and electrocardiographic abnormalities. Neurosurgery. 1999;44:34-9.

Casetta I, Granieri E. Subarachnoid hemorrhage presenting as chest pain. Am J Emerg Med. 2004;22(3):227-8

Frontera JA, Parra A, Shimbo D, Fernandez A, Schmidt JM, Peter P, et al. Cardiac arrhythmias after subarachnoid hemorrhage: risk factors and impact on outcome. Cerebrovasc Dis. 2008;26(1):71-8.

Burch GE, Meyers R, Abildskov JA. A new electrocardiographic pattern observed in cerebrovascular accidents. Circulation. 1954;9:719-23.

Banki NM, Kopelni A, Dae MW, Miss J, Tung P, Lawton MT, et al. Acute neurocardiogenic injury after subarachnoid hemorrhage. Circulation. 2005;112:3314-19.

Cruickshank JM, Neil-Dwyer G, Stott AW. Possible role of catecholamines, corticosteroids and potassium in the production of electrocardiographic abnormalities associated with subarachnoid hemorrhage. Br Med J. 1974;36:697-706.

Lee VH, Oh JK, Mulvagh SL, Wijdicks EFM. Mechanisms in neurogenic stress cardiomyopathy after aneurismal subarachnoid hemorrhage. Neurocritical Care. 2006;05:243-9.

Musuraca G, Imperadore F, Cemin C. Electrocardiographic abnormalities mimicking myocardial infarction in a patient with intracranial haemorrhage: a possible pitfall for prehospital thrombolysis. J Cardiovasc Med (Hagerstown). 2006;7(6):434-7

Velden LBJ, Otterspoor LG, Schultze Kool LJ, Biessels GJ, Verheugt FWA. Acute myocardial infarction complicating subarachnoid haemorrhage Neth Heart J. 2009;17(7-8):284-7.

Hersch C. Electrocardiographic changes in subarachnoid haemorrhage, meningitis, and intracranial space-occupying lesions. Br Heart J. 1964;26:785-93.