Subarachnoid Hemorrhage From Cavernous Malformation Masquerading as Myocardial Infarction.
Cardiac enzymes
ECG changes
Elevated troponin
Intracranial hemorrhage
Myocardial infarction
Subarachnoid hemorrhage
Journal
Journal of medical cases
ISSN: 1923-4163
Titre abrégé: J Med Cases
Pays: Canada
ID NLM: 101551824
Informations de publication
Date de publication:
Mar 2023
Mar 2023
Historique:
received:
21
02
2023
accepted:
28
03
2023
medline:
11
4
2023
entrez:
10
4
2023
pubmed:
11
4
2023
Statut:
ppublish
Résumé
Intracranial hemorrhage, including subarachnoid hemorrhage (SAH), is associated with many cardiac effects, including cardiac rhythm abnormalities, ischemic electrocardiographic (ECG) changes, elevated cardiac troponin levels, and regional wall motion abnormalities on echocardiogram. About 40% of patients with SAH demonstrate increased serum markers for myocardial necrosis. Approximately 10% of patients with SAH demonstrate left ventricular (LV) wall motion abnormalities; a subset of these patients will have irreversible myocardial damage, but most regain LV function in several weeks. Cardiac effects of SAH are thought to be a result of an imbalance of the autonomic nervous system with resultant increased catecholamine effect on the myocardial cells rather than due to preexisting coronary artery disease. These cardiovascular complications carry a prognostic significance in patients with SAH and can also be misdiagnosed as primary cardiac problems and delay the diagnosis of SAH. Herein, we present a case of a 68-year-old female who presented to the emergency department with acute onset of upper back and neck pain. She was initially misdiagnosed with myocardial infarction in view of the ischemic changes in the ECG and elevated cardiac troponins. She was started on antiplatelets and anticoagulation but was later found to have a negative coronary angiography and was diagnosed with SAH via a computed tomography (CT) scan. Intracranial hemorrhage can be associated with elevated cardiac enzymes and ECG changes and can sometimes masquerade as an acute coronary syndrome (ACS). A careful history and examination and a high index of clinical suspicion are pivotal in such cases since early diagnosis significantly impacts prognosis and prevents the inadvertent use of antiplatelets and anticoagulation, which can be detrimental if used in such cases.
Identifiants
pubmed: 37032743
doi: 10.14740/jmc4064
pmc: PMC10079361
doi:
Types de publication
Case Reports
Langues
eng
Pagination
105-110Informations de copyright
Copyright 2023, Abdalla et al.
Déclaration de conflit d'intérêts
There is no conflict of interest in this case report from all authors.
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