A Case of Subarachnoid Hemorrhage Mimicking Acute Coronary Syndrome

Abstract

A 61 years old man patient was admitted to emergency department with complaint of headache and dizziness lasting for one week. Mild hypertension and sinusal bradicardia were existed in pysical examination. His ECG revealed sinusal bradicardia and long QTc (64.6msn), broad and increased amlitude T wave in anterior leads, biphasic T wave inversion in inferior leads were present. The patient was misdiagnosed as acute coronary syndrome with long QT. Following second days conscious disturbance and lethargy were observed. Urgent CT revealed subarachnoid hemorrhage. Anticoagulation and antiplatelet therapy were stopped. Patient was referred to neurosurgery department. In case of subarachnoid hemorrhage the ECG can mimick acute coronary syndrome. Anticoaculation therapy can be harmful. In the presence of headache, dizziness without chest pain complicated with ECG abnormalities such as long QT, ST/T changes and arrythmia, high suspicion of subarachnoid hemorrhage should be made

Keywords

• Subarachnoid hemorrhage, Acute coronary syndrome, ECG

Akut Koroner Sendromu Taklit Eden Subaraknoid Kanama Vakası

Abstract

61 yaşında erkek hasta 1 haftadır süren başağrısı ve baş dönmesi yakınmaları ile acil servise başvurdu. Fizik muayenede hafif yüksek arteryel tansiyon ve sinüs bradikardisi tespit edildi. EKG de uzun QTc (64.6 msn ), göğüs derivasyonlarında artmış T dalga amplitüdü, inferior derivasyonlarda bifazik T negatifliği izlendi (Resim 1). Hasta akut koroner sendrom ve uzun QT sendromu öntanılarıyla koroner yoğun bakım ünitesine yatırıldı. İzleyen ikinci günde şuur bulanıklığı ve letarji gelişen hastada acil BT çekildi ve subaraknoid kanama izlendi. Antikoagülan ve antiplatelet tedavi kesildi ve hasta beyin cerrahisine devredildi. Subaraknoid kanamalı hastalardaki EKG değişiklikleri akut koroner sendromla karıştırılabilir. Bu durumda antikoagülasyon zararlı olabilir. Göğüs ağrısı olmaksızın başağrısı,baş dönmesi olan hastalarda uzun QT, aritmi, ST/T dalga EKG değişiklikleri varsa, subaraknoid kanamadan kuvvetle şüphelenilmelidir.

Keywords

• Subaraknoid kanama, Akut koroner sendrom, EKG, Uzun QT

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