The ischaemic ECG: is it all in the head?

Acute cerebrovascular events including ischaemic stroke and subarachnoid haemorrhage are known to be associated with left ventricular dysfunction and significant electrocardiographic abnormalities that can mimic cardiac ischaemia. The authors present a case in which an intracerebral haemorrhage was diagnosed during the treatment of pneumonia in a 62-year-old woman, with repolarisation abnormalities on the ECG acting as the key diagnostic clue in the absence of clinical or radiological evidence of ventricular dysfunction. The pneumonia was treated without complication, and there were no long-term respiratory, cardiac or neurological sequelae. Diagnostic cardiac imaging, including angiography at follow-up, confirmed the absence of significant coronary artery disease, suggesting a non-coronary aetiology for these ECG changes. The authors emphasise that when presentation is atypical for acute coronary syndrome, non-specific ECG changes could point to a primary cerebrovascular pathology, even in the absence of neurological or cardiac symptoms.