ST‑segment elevation associated with intraparenchymal hemorrhage: A case report

Abstract

The electrocardiogram (ECG) changes in patients with intraparenchymal hemorrhage (IPH) have remained largely elusive and no case reports are currently available in the scientific literature. The medical management of a patient with ST-segment elevation associated with IPH was described in the present study. The case report describes a 78-year-old male patient who presented with ST-segment elevation in V1, V2, V3 and V4 on ECG. Initially, the case was managed therapeutically as an acute myocardial infarction. Later, the patient was transferred to a higher-level hospital, where a new ECG confirmed ST-segment elevation. Simple skull tomography was also performed, which revealed a spontaneous right basal ganglion in the context of an acute cerebrovascular accident of hypertensive origin. A transthoracic ECG was ordered, which revealed an ejection fraction of 65% with type I diastolic dysfunction due to relaxation disorders and without any signs of ischemia, intracavitary masses or thrombi. In addition to the presence of nonspecific ECG findings, clinicians should consider immediate brain computed tomography to confirm intracranial hemorrhage.

Keywords: electrocardiography; intracranial hemorrhage; myocardial infarction.

Figure 1

Electrocardiogram performed at the low-complexity hospital in August 2021 during the first 10 min after the patient's admission to the hospital. Sinus rhythm and a heart rate of 49 beats per min were observed, and ST-segment elevation was detected in V1, V2 and V3.

Figure 2

Electrocardiogram performed at the high-complexity hospital in August 2021 during the first 30 min after the patient's admission to the hospital. Sinus rhythm, heart rate of 50 beats per min, and ST-segment elevation in V3 and V4.

Figure 3

Simple skull tomography upon admission. A right temporal intraparenchymal hematoma (arrows) with vasogenic edema and ventricular involvement of 1x30x40 mm was observed (on the left, an axial section is observed and on the right, a coronal section is present).

Figure 4

Simple skull tomography (control at 24 h). A right temporal intraparenchymal hematoma (arrows) with vasogenic edema and ventricular involvement was observed without any changes compared with the previous one (on the left, an axial section is observed and on the right, a coronal section is present).

Figure 5

Transthoracic echocardiogram (taken 24 h after admission). The image suggests no akinesia or hypokinesia, but diastolic dysfunction and relaxation disorders are present; no signs of ischemia, intracavitary masses or thrombi were observed (left panel: Parasternal long axis cut-systole; right panel: Parasternal long axis cut-diastole).