Hold the heparin

Dynamic ischemic-type electrocardiographic T-wave inversions raise the possibility of myocardial ischemia or infarction but are actually a nonspecific finding. We present a case of a young man presenting with headache and dizziness found to have marked hypertension, deepening T-wave inversions, and troponin elevation. Initial concerns were for acute coronary syndrome (ACS); however, before anticoagulant and antithrombotic therapy was instituted, further evaluation with noncontrast computed tomography of the head showed intraventricular hemorrhage. Electrocardiographic T-wave inversions are nonspecific and have a broad differential diagnosis, but ACS is of the highest concern especially in the setting of elevated troponin. However, as in this case, T-wave inversion and troponin elevation have been well described in intracranial bleeds as well, and full evaluation is required for such findings before initiation of therapy for presumed ACS to avoid a potentially catastrophic outcome.