Subarachnoid hemorrhage mimicking ST-segment elevation myocardial infarction after return of spontaneous circulation

Area of Science:

• Cardiology
• Neurology
• Emergency Medicine

Background:

• Electrocardiogram (ECG) changes, including ST-T wave abnormalities, are frequently observed in patients with subarachnoid hemorrhage (SAH).
• These ECG findings can mimic acute coronary syndromes, such as ST-segment elevation myocardial infarction (STEMI), leading to diagnostic challenges.
• Elevated cardiac enzymes and impaired regional myocardial function are also commonly reported in SAH.

Purpose of the Study:

• To report a case of out-of-hospital cardiac arrest (OHCA) initially suspected to be STEMI based on ECG and echocardiography.
• To highlight the importance of considering SAH in the differential diagnosis of cardiac emergencies presenting with ECG abnormalities.
• To illustrate a case where emergent coronary angiography revealed normal coronary arteries, prompting further investigation into alternative causes of cardiac arrest.

Main Methods:

• Case report of an OHCA survivor.
• Initial assessment included ECG and bedside echocardiography, raising suspicion for STEMI.
• Emergent coronary angiography was performed.
• Diagnosis of SAH was established as the underlying cause.

Main Results:

• The patient presented with ECG findings highly suggestive of STEMI.
• Echocardiography showed regional myocardial wall motion abnormalities.
• Coronary angiography demonstrated normal coronary arteries, ruling out acute coronary occlusion.
• Subarachnoid hemorrhage was identified as the cause of the cardiac arrest.

Conclusions:

• SAH can present with dramatic ECG changes and cardiac dysfunction that closely mimic acute myocardial infarction.
• In cases of suspected myocardial infarction with normal coronary arteries, SAH should be strongly considered as a potential etiology.
• Early recognition and diagnosis of SAH are crucial for appropriate management and improved outcomes in patients with cardiac emergencies.