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Severe intracranial bleeding mimicking acute inferior myocardial infarction with right ventricular involvement
F Jung1, M Setzer, S H Hohnloser
1Division of Cardiology, Department of Medicine, Johann Wolfgang Goethe University, Frankfurt am Main, Germany. FJung@em.uni-frankfurt.de
Insights
Severe brain bleeds can mimic heart attacks, causing rare electrocardiogram (ECG) changes. Prompt diagnosis is crucial to differentiate intracranial hemorrhage from acute myocardial infarction, guiding appropriate treatment.
Area of Science:
- Cardiology
- Neurology
Background:
- Electrocardiographic (ECG) changes and left ventricular wall motion abnormalities are known complications of severe intracranial hemorrhage.
- However, ECG findings indicative of acute myocardial infarction (MI) in this context are exceptionally rare.
Observation:
- A 45-year-old female presented with unconsciousness and respiratory distress post-procedure.
- She exhibited ECG changes consistent with an inferior myocardial infarction involving the right ventricle.
- Coronary angiography showed normal coronary arteries, but left ventriculography revealed significant anteroseptal wall motion abnormalities.
Findings:
- Cranial computed tomography confirmed massive intracranial bleeding.
- This case highlights the rare but critical association between intracranial hemorrhage and apparent acute myocardial infarction.
Implications:
- Clinicians must consider acute myocardial infarction in patients with unexplained loss of consciousness or unresponsiveness, especially after procedures.
- Rapid diagnostic evaluation is essential to distinguish between intracranial hemorrhage and myocardial infarction to prevent inappropriate thrombolytic or anticoagulant therapy.
Abstract:
Electrocardiographic (ECG) changes and wall motion abnormalities of the left ventricle have been observed in patients with severe intracranial hemorrhage. However, ECG evidence of an acute myocardial infarction in this setting is extremely rare but may have important therapeutic consequences. We report the case of a 45-year-old female who became unconscious with respiratory insufficiency after an endoscopic retrograde cholangiopancreaticoscopy with ECG changes consistent of an inferior myocardial infarction with right ventricular involvement. Immediate coronary angiography revealed normal coronaries; however, left ventricular angiography showed extensive wall motion abnormalities predominantly in the anteroseptal region. Immediate cranial computer tomography demonstrated massive intracranial bleeding. Intracranial hemorrhage can be associated in the initial phase with ECG evidence of an acute myocardial infarction. This has to be taken into consideration in the setting of unexplained loss of consciousness or nonresponsiveness of a patient. A rapid diagnostic evaluation has to be initiated to rule out a myocardial infarction and to diagnose intracranial hemorrhage before the use of thrombolytic or anticoagulant therapy.