Key result
A 69-year-old woman with subarachnoid haemorrhage presented with extensive ECG changes mimicking acute coronary syndrome, highlighting the potential for extra-cardiac pathology to cause such changes.
Case Report (n=1)
Highlights the importance of recognizing extra-cardiac causes, such as subarachnoid haemorrhage, for widespread ECG abnormalities and raised troponin mimicking acute coronary syndrome.
Consider neurogenic causes in ACS-mimicking ECGs; single case leaves open broader validation.
A 69-year-old woman presented after collapsing. She denied chest pain, breathlessness or headache. She was afebrile and vital signs were unremarkable. She was confused but the remaining physical examination was unremarkable. Routine blood tests were unremarkable. Cardiac enzymes were raised with a troponin I of 0.54. ECG showed Q waves in leads V1-V3 and widespread T wave inversion in leads II, III, aVF and V1-V6. Acute coronary syndrome (ACS) was suspected and antiplatelet treatment started. The following day her confusion worsened. Further review of the ECG found extensive changes unexplained by occlusion of a single artery suggesting extra-cardiac pathology. An urgent CT head was arranged and revealed subarachnoid haemorrhage. ACS treatment was stopped and she was transferred to neurosurgery where her right posterior communicating artery aneurysm was coiled. Fortunately her recovery was uneventful and she was discharged home with no neurological impairment.
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Bhattacharya et al. (2011) conducted a case report in Subarachnoid haemorrhage (n=1). Subarachnoid haemorrhage was evaluated. A 69-year-old woman with subarachnoid haemorrhage presented with extensive ECG changes mimicking acute coronary syndrome, highlighting the potential for extra-cardiac pathology to cause such changes.
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