DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20204262

Subarachnoid haemorrhage mimicking unstable angina: a case report

Subhash Chand, Subhash Chander, Gaveshna Gargi, Tarun Sharma, Rittin Sharma

Abstract


Subarachnoid haemorrhage (SAH) is medical emergency caused by bleeding into the subarachnoid space. It is caused by rupture of an aneurysm or arteriovenous malformations (AVM). Symptoms of SAH are severe headache, nausea, vomiting, impaired consciousness and seizures. Neck stiffness and neck pain are relatively uncommon. Risk factors are high blood pressure, smoking, family history, alcoholism and even cocaine use. Diagnosis is mainly made by CT scan of head which should be done within six hours of the onset of symptoms and occasionally lumber puncture can also be done. An electrocardiogram (ECG) of all patients with subarachnoid should be done because patient with SAH can have myocardial ischemia due to increased level of circulating catecholamines or due to autonomic stimulation of the brain. ECG changes associated with SAH primarily reflect repolarisation abnormalities involving ST segment, T wave, U wave and QTc interval. Myocardial ischemia or infarction is often suspected in patients with SAH. Even troponin levels may be raised in these patients. However, suspicion of SAH is a contraindication for thrombolytic and anticoagulant therapy. This is a case of SAH which was initially treated for acute coronary syndrome (ACS) on the basis of symptoms and gradually changing ECG findings but on CT Head, patient was having SAH.


Keywords


Subarachnoid space, SAH, ECG

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References


Goldstein DS. The electrocardiogram in stroke: relationship to pathophysiological type and comparison with prior tracings. Stroke. 1979;10(3):253-9.

Ahmadian A, Mizzi A, Banasiak M, Downes K, Camporesi EM, Sullebarger JT et al. Cardiac manifestations of subarachnoid haemorrhage. Heart Lung Vessel. 2013;5(3):168-78.

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

Arnaout M, Mongardon N, Deye N, Legriel S, Dumas F, Sauneuf B et al. Out-of-hospital cardiac arrest from brain cause: epidemiology, clinical features, and outcome in a multicenter cohort. Crit Care Med. 2015;43(2):453-60.

Chatterjee S. ECG Changes in Subarachnoid Haemorrhage: A Synopsis. Neth Heart J. 2011;19(1):31-4.

Masuda T, Sato K, Yamamoto S, Matsuyama N, Shimohama T, Matsunaga A et al. Sympathetic nervous system activity and myocardial damage immediately after subarachnoid haemorrhage in a unique animal model. Stroke. 2002;33(6):1671-6.

Beard EF, Robertson JW, Robertson RCL. Spontaneous arachnoid haemorrhage stimulating acute myocardial infarction. Am Heart J. 1959;58:755-9.