[Subarachnoid haemorrhage presenting clinically as circulatory arrest in acute myocardial infarction]

A 59-year-old woman and a 41-year-old man were both brought to the Cardiac Emergency Clinic with circulatory arrest on the basis ofpulseless electrical activity. The first patient had had no prodromal symptoms and the second patient had visited his general practitioner 2 weeks earlier because of pain in the head and neck. In both patients, electrocardiography and echocardiography suggested acute myocardial infarction. However, both patients proved to be suffering from a subarachnoid haemorrhage (SAH) and both died. One-third ofthe patients with SAH are comatose at presentation. Cardiac manifestations such as ECG-abnormalities, cardiac arrhythmias, cardiopulmonary arrest, elevated troponin values, and signs of left ventricular dysfunction are common. These findings can be misleading and may have catastrophic consequences if anticoagulant therapy is initiated because of a presumed myocardial infarction. Low-threshold CT-scanning of the brain is therefore advised for patients who remain comatose after resuscitation for cardiac arrest in the presence of an atypical anamnesis.