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A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis
18:11

A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis

Published on: December 28, 2012

Headache as a manifestation of fatal myocardial infarction

J Auer1, R Berent, E Lassnig

  • 1Department of Internal Medicine, Division of Cardiology and Intensive Care, General Hospital Wels, Austria.

Neurological Sciences : Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
|March 29, 2002
PubMed

Insights

Headache can be the sole symptom of myocardial ischemia, a heart attack. This rare presentation, often due to nerve pathway convergence, makes diagnosis challenging and requires high clinical suspicion.

Area of Science:

  • Cardiology
  • Neurology

Background:

  • Myocardial ischemia commonly presents as chest pain, but atypical symptoms can occur.
  • The convergence of cardiac and somatic afferent pathways in the central nervous system may explain referred pain.
  • Headache as an isolated symptom of cardiac ischemia is exceptionally rare.

Observation:

  • A 47-year-old male presented with isolated occipital headache as the sole presenting symptom.
  • Electrocardiography showed ST-segment elevation and depression, indicative of acute myocardial infarction.
  • Ventricular fibrillation occurred during monitoring, leading to unsuccessful resuscitation.

Findings:

  • Autopsy revealed severe coronary artery disease, including occlusion of the left anterior descending artery and significant stenosis of the right coronary artery.
  • The patient's myocardial ischemia manifested exclusively as headache, with no typical chest pain.
  • This case highlights the potential for neurological symptoms to be the primary manifestation of acute cardiac events.

Implications:

  • Clinicians must maintain a high index of suspicion for myocardial ischemia in patients presenting with unexplained headaches, even in the absence of chest pain.
  • Understanding the neuroanatomical basis of referred pain is crucial for diagnosing rare presentations of ischemic heart disease.
  • This case underscores the importance of considering cardiac etiologies in emergency room presentations of severe headache.

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