Cardiovascular Diseases & Diagnosis

Subarachnoid Hemorrhage Masquerading as Takotsubo Cardiomyopathy

Abstract

Ilia Davarashvili, Rami Jubeh and Jonathan Balkin

Background: Patients presenting with suspected ST-segment elevation myocardial infarction (STEMI) may have important alternative diagnoses (e.g., aortic dissection, pulmonary emboli) or safety concerns for STEMI management (e.g. head trauma). Subarachnoid hemorrhage (SAH) is a known cause of electrocardiographic and echocardiographic changes that may mimic acute coronary syndromes (ACS) resulting in delay of diagnosis and treatment of the primary disease.
Case report: A 50-year-old female patient was admitted with suspected STEMI. She had symptoms of vomiting for three days prior to admission. She had a medical history of schizoaffective disorder, treated with selective serotonin reuptake inhibitors (SSRIs). The electrocardiogram (ECG) on presentation showed sinus rhythm with 3 mm ST-segment elevation in leads L1, AVL, V2-V5 and reciprocal changes in L3, aVf) Coronary angiography showed normal coronary arteries and Takotsubo Cardiomyopathy was diagnosed. Urgent cranial CT of the head revealed extensive SAH.
Conclusion: Urgent cranial CT should be performed in all patients with neurologic symptoms before cardiac catheterization is performed.