Abstract
Electrocardiogram (ECG) changes suggestive of cardiac ischemia are frequently demonstrated in patients with ischemic stroke and subarachnoid hemorrhage. However, little is known of such changes particularly acute ST segment myocardial infarction (STEMI) in patients with intracerebral hemorrhage (ICH), especially after neurosurgery. We present a patient with intraparenchymal hemorrhage due to cerebral arteriovenous malformation (AVM) who exhibited acute STEMI after neurosurgery. Serial cardiac biomarkers and echocardiograms were performed which did not reveal any evidence of acute myocardial infarction. The patient was managed conservatively from cardiac stand point with no employment of anticoagulants, antiplatelet therapy, fibrinolytic agents, or angioplasty and recovered well with minimal neurological deficit. This case highlights that diffuse cardiac ischemic signs on the ECG can occur in the setting of an ICH after neurosurgery, potentially posing a difficult diagnostic and management conundrum.
Highlights
A number of patients with stroke and aneurysmal subarachnoid hemorrhage have changes on electrocardiogram (ECG) [1]
We present a patient with intraparenchymal hemorrhage due to cerebral arteriovenous malformation (AVM) who exhibited acute ST segment elevation suggestive of myocardial infarction in ECG after neurosurgery
Serial cardiac biomarkers and echocardiograms were performed which did not reveal any evidence of acute coronary event and the ECG changes resolved spontaneously
Summary
A number of patients with stroke and aneurysmal subarachnoid hemorrhage (aSAH) have changes on electrocardiogram (ECG) [1]. They can be in the form of T wave inversions, QT interval prolongation, and others. Acute cerebrovascular events can be associated with fleeting ECG changes or lead to fatal arrhythmias. The mechanism for these changes is poorly understood. Our case represents an uncommon clinical scenario with ICH patients and the challenges in treatment. This case is discussed here for its rarity with a brief review of the literature
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