Subarachnoid hemorrhage can mimic acute coronary syndrome and Takotsubo cardiomyopathy, highlighting the need for cranial CT in patients with neurologic symptoms before cardiac catheterization.
Subarachnoid hemorrhage may mimic Takotsubo; this case leaves open whether cranial imaging is needed before catheterization in select patients.
Background: Patients presenting with suspected ST-segment elevation myocardial infarction (STEMI) may have important alternative diagnoses (e.g., aortic dissection, pulmonary emboli) or safety concerns for STEMI management (e.g. head trauma). Subarachnoid hemorrhage (SAH) is a known cause of electrocardiographic and echocardiographic changes that may mimic acute coronary syndromes (ACS) resulting in delay of diagnosis and treatment of the primary disease.Case report: A 50-year-old female patient was admitted with suspected STEMI. She had symptoms of vomiting for three days prior to admission. She had a medical history of schizoaffective disorder, treated with selective serotonin reuptake inhibitors (SSRIs). The electrocardiogram (ECG) on presentation showed sinus rhythm with 3 mm ST-segment elevation in leads L1, AVL, V2-V5 and reciprocal changes in L3, aVf) Coronary angiography showed normal coronary arteries and Takotsubo Cardiomyopathy was diagnosed. Urgent cranial CT of the head revealed extensive SAH.Conclusion: Urgent cranial CT should be performed in all patients with neurologic symptoms before cardiac catheterization is performed.
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Davarashvili et al. (2018) studied this question.
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