open access

Vol 46, No 4 (2014 Sep-Oct)
Case reports
Submitted: 2014-10-07
Accepted: 2014-10-07
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Subarachnoid haemorrhage imitating acute coronary syndrome as a cause of out-of-hospital cardiac arrest – case report

Paweł Lewandowski
DOI: 10.5603/AIT.2014.0047
·
Anaesthesiol Intensive Ther 2014;46(4):289-292.

open access

Vol 46, No 4 (2014 Sep-Oct)
Case reports
Submitted: 2014-10-07
Accepted: 2014-10-07

Abstract

Background: Severe subarachnoid haemorrhage (SAH) is a common cause of cardiac arrest. The survival of patients with out-of-hospital cardiac arrest (OHCA) due to SAH is extremely poor. Electrocardiographic and echocardiographic changes associated with SAH may mimic changes caused by acute coronary syndromes (ACS) and thus lead to delayed treatment of the primary disease. Misdiagnosed SAH due to ACS mask can have an influence on patient outcomes.

Case report: A 47-year-old man presented with a history of out-of-hospital cardiac arrest due to asystole. He had a medical history of hypertension, smoking, and a diffuse, severe headache for one week. The ECG showed atrial fibrillation, 0,2 mV ST-segment elevation in leads aVR and V1-V3 and 0.2 mV ST-segment depression in leads I, II, aVL and V4-V6. Echocardiography revealed left ventricular function impairment (ejection fraction < 20%). The CK-MB activity was 98 U L-1 and the troponin I concentration was 0.59 μg L-1. ACS was suspected. Coronarography did not reveal any changes in the coronary arteries. An urgent CT of the head was arranged and showed an extensive SAH.

Conclusions: It appears that an urgent CT of the head is the most effective method for the early identification of SAH-induced OHCA, especially in patients with prodromal headache, no history of the symptoms of ACS and CA due to asystole/pulseless electrical activity (PEA). Out-of-hospital cardiac arrest (OHCA) predominantly develops due to acute coronary syndrome (ACS). Extra-cardiac causes, e.g., subarachnoid haemorrhage (SAH), are less common. The purpose of the present case report was to describe a patient with OHCA due to subarachnoid haemorrhage imitating acute coronary syndrome.

Abstract

Background: Severe subarachnoid haemorrhage (SAH) is a common cause of cardiac arrest. The survival of patients with out-of-hospital cardiac arrest (OHCA) due to SAH is extremely poor. Electrocardiographic and echocardiographic changes associated with SAH may mimic changes caused by acute coronary syndromes (ACS) and thus lead to delayed treatment of the primary disease. Misdiagnosed SAH due to ACS mask can have an influence on patient outcomes.

Case report: A 47-year-old man presented with a history of out-of-hospital cardiac arrest due to asystole. He had a medical history of hypertension, smoking, and a diffuse, severe headache for one week. The ECG showed atrial fibrillation, 0,2 mV ST-segment elevation in leads aVR and V1-V3 and 0.2 mV ST-segment depression in leads I, II, aVL and V4-V6. Echocardiography revealed left ventricular function impairment (ejection fraction < 20%). The CK-MB activity was 98 U L-1 and the troponin I concentration was 0.59 μg L-1. ACS was suspected. Coronarography did not reveal any changes in the coronary arteries. An urgent CT of the head was arranged and showed an extensive SAH.

Conclusions: It appears that an urgent CT of the head is the most effective method for the early identification of SAH-induced OHCA, especially in patients with prodromal headache, no history of the symptoms of ACS and CA due to asystole/pulseless electrical activity (PEA). Out-of-hospital cardiac arrest (OHCA) predominantly develops due to acute coronary syndrome (ACS). Extra-cardiac causes, e.g., subarachnoid haemorrhage (SAH), are less common. The purpose of the present case report was to describe a patient with OHCA due to subarachnoid haemorrhage imitating acute coronary syndrome.

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Keywords

cardiac arrest, subarachnoid haemorrhage, acute coronary syndrome

About this article
Title

Subarachnoid haemorrhage imitating acute coronary syndrome as a cause of out-of-hospital cardiac arrest – case report

Journal

Anaesthesiology Intensive Therapy

Issue

Vol 46, No 4 (2014 Sep-Oct)

Pages

289-292

DOI

10.5603/AIT.2014.0047

Bibliographic record

Anaesthesiol Intensive Ther 2014;46(4):289-292.

Keywords

cardiac arrest
subarachnoid haemorrhage
acute coronary syndrome

Authors

Paweł Lewandowski

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