May 5, 2020

Stress cardiomyopathy misinterpreted as ST-segment elevation myocardial infarction in a patient with aneurysmal subarachnoid hemorrhage: a case report

Romanian Journal of Internal Medicine = Revue Roumaine De Médecine Interne
Iulian EnacheCristina Tiu

Abstract

Cardiac abnormalities are frequently reported in acute subarachnoid hemorrhage (SAH) patients. However, frank ST-elevation and myocardial dysfunction mimicking acute coronary syndrome is a rare occurrence. Systemic and local catecholamine release mediate myocardial injury and may explain raised troponin levels, concordant regional wall motion abnormalities and systolic dysfunction. These findings can pose a significant problem in the acute setting where "time-is-muscle" paradigm can rush clinicians towards a "rule - in" diagnosis of acute myocardial infarction. We present the case of a 60-year-old male who presented to a regional emergency department with loss of consciousness, chest pain and headache. His ECG showed ST-elevation in precordial leads with corresponding region wall motion abnormalities and dynamically elevated troponin levels which supported a diagnosis of acute myocardial infarction. Percutaneous coronary intervention was attempted but found no hemodynamically significant lesions and the patient was managed conservatively with antithrombotic treatment. Further work-up for his headache led to the diagnosis of aneurysmal SAH and subsequent endovascular coiling. The patient was discharged with a good clinical outco...Continue Reading

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Mentioned in this Paper

Subarachnoid Hemorrhage, Aneurysmal
Myocardial Dysfunction
Lesion
Finding
Myocardium
ST segment elevation myocardial infarction
Unconscious State
Biological Markers
Troponin
Headache

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