The ischaemic ECG: is it all in the head?

Area of Science:

• Neurology
• Cardiology
• Medical Diagnostics

Background:

• Acute cerebrovascular events, such as ischemic stroke and subarachnoid hemorrhage, are frequently linked to left ventricular dysfunction and electrocardiographic (ECG) abnormalities that can mimic cardiac ischemia.
• These ECG changes can complicate the diagnosis of primary cardiac events.

Observation:

• A 62-year-old woman presented with pneumonia, and during treatment, an intracerebral hemorrhage was diagnosed.
• Repolarization abnormalities on the ECG were the primary diagnostic indicator, despite the absence of clinical or radiological signs of ventricular dysfunction.
• Pneumonia treatment was uncomplicated, with no lasting sequelae.

Findings:

• Follow-up cardiac imaging, including angiography, ruled out significant coronary artery disease.
• This suggested a non-coronary origin for the observed ECG changes.

Implications:

• Non-specific ECG changes, particularly when atypical for acute coronary syndrome, may indicate underlying cerebrovascular pathology.
• Clinicians should consider primary cerebrovascular disease in the differential diagnosis of unexplained ECG abnormalities, even without overt neurological or cardiac symptoms.