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Case Reports
. 2021 Oct 25;13(10):e19030.
doi: 10.7759/cureus.19030. eCollection 2021 Oct.

ST Depression in the Setting of Subarachnoid Hemorrhage

Ala Mustafa  1 , Nathaniel Hitt  1 , Elias Smirlis  1 , Ketan Koranne  2
Affiliations
Case Reports

ST Depression in the Setting of Subarachnoid Hemorrhage

Ala Mustafa et al. Cureus. .

Abstract

We present a case report of a patient presenting with subarachnoid hemorrhage whose electrocardiogram (ECG) mimicked non-ST-elevation myocardial infarction. A 36-year-old male with a past medical history of resistant hypertension, previous severe acute respiratory syndrome coronavirus 2 infection, and alcohol abuse presented to the hospital after cardiac arrest. He was taken to the catheterization lab upon arrival and was found to have an unremarkable coronary angiogram. After angiography, computerized tomography (CT) head was performed revealing an acute, large-volume, subarachnoid hemorrhage. Subsequent CT angiogram of the head confirmed this with source noted to be a ruptured aneurysm of the anterior communicating artery. ST depression on ECG has been reported in patients who have suffered a subarachnoid hemorrhage. Although the most common etiology of cardiac arrest is an acute coronary syndrome, other etiologies based on a patient's past medical history need to remain in the differential. Recognition of ECG changes may lead to earlier diagnosis and decreased mortality in subarachnoid patients.

Keywords: 12-lead ecg; angiogram; covid 19; st depression; subarachnoid hemmorhage.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. ECG on admission showing diffuse ST segment depressions
ECG, electrocardiogram
Figure 2
Figure 2. Subsequent ECG demonstrated diffuse ST segment depressions with a mild ST elevation in the aVR lead
ECG, electrocardiogram
Figure 3
Figure 3. (Right) Shows extensive intracranial subarachnoid hemorrhage visualized during hospitalization, compared to (left) of CT head one year prior
CT, computed tomography
Figure 4
Figure 4. A repeat ECG 27 hours after admission demonstrated a resolution of the ST depressions initially present, QTc prolongation, and T wave inversions in leads I, aVL, and V4-V6
ECG, electrocardiogram
See this image and copyright information in PMC

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