The great mimicker: a unique case of diffuse subarachnoid haemorrhage simulating acute myocardial infarction

Abstract

Subarachnoid haemorrhage (SAH) is a rare yet consequential medical emergency that may mimic an acute myocardial infarction (MI). SAH causes enhanced sympathetic activity, culminating in the development of neurogenic stunned myocardium (NSM), which presents as ST-segment deviations, prolonged QT intervals, T-wave inversions or Q-waves. Reperfusion therapy is contraindicated for SAH because of an increased risk of bleeding and death. Therefore, a prompt diagnosis is crucial. Here, we report a unique case of massive SAH presenting as diffuse ST-segment deviation simulating an acute MI. Our patient was brought to the emergency department after a cardiac arrest and died on day 2 of admission.

Keywords

• subarachnoid haemorrhage
• acute myocardial infarction
• neurogenic stunned myocardium
• electrocardiogram
• st-segment depression