Key result
Aneurysmal subarachnoid hemorrhage can present with severe cardiac dysfunction and pulmonary edema mimicking acute coronary syndrome, requiring careful diagnosis to avoid dangerous anticoagulant therapy.
Case Report (n=1)
No
Severe myocardial damage with cardiogenic shock can rarely be the presenting sign of a subarachnoid hemorrhage, mimicking an acute coronary syndrome.
Raises caution for empiric anticoagulation in atypical cardiogenic shock; leaves open prospective validation of neurocardiogenic diagnostic algorithms.
The subarachnoid hemorrhage (SAH) is definitely the best descriptive model of the interaction between cardiovascular system and cerebral damage. The underlying mechanism of cardiovascular alterations after SAH is linked to the adrenergic discharge related to aneurysm rupture. Cardiac and pulmonary complications are common after severe brain injury, especially the aneurismal subarachnoid hemorrhage. Acute neurogenic pulmonary edema is not exceptional; it may occur in 20% of cases and commonly follows a severe subarachnoid hemorrhage. Severe myocardial damage with cardiogenic shock may possibly reveal the SAH (3% of cases) and mislead to wrong diagnosis of ACS with dramatic therapeutic consequences. The contribution of CT and cerebral angiography is essential for diagnosis and treatment. Surgical or endovascular treatment depends on location, size and shape of the aneurysm, on patient's age, neurological status and existence of concomitant diseases. We report the case of a 58 years old patient, with a past medical history of diabetes and hypertension, admitted for acute pulmonary edema with cardiogenic shock. This case illustrates an unusual presentation of aneurismal SAH in a patient presenting with an acute coronary syndrome.
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Hatim et al. (2015) conducted a case report in Subarachnoid hemorrhage presenting as acute coronary syndrome (n=1). Endovascular embolization was evaluated on Clinical recovery. Aneurysmal subarachnoid hemorrhage can present with severe cardiac dysfunction and pulmonary edema mimicking acute coronary syndrome, requiring careful diagnosis to avoid dangerous anticoagulant therapy.
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