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Subarachnoid hemorrhage simulating myocardial infarction

E de Marchena1, J M Pittaluga, A C Ferreira

  • 1Department of Medicine, University of Miami School of Medicine, Florida 33101, USA.

Catheterization and Cardiovascular Diagnosis
|February 1, 1996
PubMed
Summary

Subarachnoid hemorrhage can mimic myocardial infarction on ECG, but coronary angiography is crucial for accurate diagnosis. Autopsy revealed generalized myocytolysis, not infarction, highlighting the need for prompt cardiac evaluation in altered mental status patients.

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Area of Science:

  • Cardiology
  • Neurology
  • Pathology

Background:

  • Subarachnoid hemorrhage (SAH) can present with cardiac manifestations.
  • Electrocardiographic (ECG) changes suggestive of myocardial infarction (MI) are sometimes observed in SAH patients.

Observation:

  • A patient with SAH exhibited ECG findings consistent with transmural MI.
  • Coronary angiography revealed normal coronary arteries.
  • Autopsy showed generalized myocytolysis without evidence of MI.

Findings:

  • The ECG changes were attributed to the SAH, not an acute coronary event.
  • Generalized myocytolysis, a stress-induced cardiomyopathy, can mimic MI.
  • Normal coronaries ruled out obstructive coronary artery disease.

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Implications:

  • This case underscores the importance of considering non-coronary causes for MI symptoms in SAH.
  • Acute coronary angiography is vital for differentiating true MI from SAH-induced cardiac changes.
  • Prompt and accurate diagnosis is essential for appropriate patient management and treatment strategies.