A Case of Subarachnoid Hemorrhage Mimicking Acute Coronary Syndrome

Öz

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

Anahtar Kelimeler

• Subarachnoid hemorrhage, Acute coronary syndrome, ECG

Akut Koroner Sendromu Taklit Eden Subaraknoid Kanama Vakası

Öz

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.

Anahtar Kelimeler

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

Kaynakça

1. Longstreth WT, Nelson LM, Koepsell TD, van Belle G. Clinical course of spontaneous subarachnoid hemorrhage: a population-based study in King County, Washington. Neurology. 1993;43:712-718.
2. Brouwers PJ, Wijdicks EF, Hasan D, et al. Serial electrocardiographic subarachnoid hemorrhage. Stroke. 1989;20:1162-1167.
3. Cropp GJ, Manning GW. Electrocardiographic changes simulating myocardial ischemia and infarction associated with spontaneous intracranial hemorrhage. Circulation. 1960;22:25-38.
4. Carruth JE, Silverman ME. Torsade de pointe atypical ventricular tachycardia complicating subarachnoid hemorrhage. Chest. 1980;78:886-888.
5. Eisalo A, Peräsalo J, Halonen PI. Electrocardiographic abnormalities and some laboratory findings in patients with subarachnoid haemorrhage. Br Heart J. 1972;34:217-226.
6. Yuki K, Kodama Y, Onda J, Emoto K, Morimoto T, Uozumi T. Coronary vasospasm following subarachnoid hemorrhage as a cause of stunned myocardium: a case report. J Neurosurg. 1991;75:308-311.
7. Oppenheimer SM, Cechetto DF, Hachinski VC. Cerebrogenic cardiac arrhythmias. Arch Neurol. 1990;47:513-519.
8. Doshi R, Neil-Dwyer G. Hypothalamic and myocardial lesions after subarachnoid hemorrhage. J Neurol Neurosurg Psychiatry. 1977;40:821-826.

9. Svigelj V, Grad A, Kiauta T. Heart rate variability, norepinephrine and ECG changes in subarachnoid hemorrhage patients. Acta Neurol Scand.1996;94:120-126.
10. Davies KR, Gelb AW, Manninen PH, Boughner DR, Bisnaire D. Cardiac function in aneurysmal subarachnoid haemorrhage: a study of electrocardiographic and Anaesth.1991;67:58-63.
11. abnormalities. Br J
12. Mayer SA, Fink ME, Homma S, et al. Cardiac injury associated with neurogenic pulmonary edema following subarachnoid hemorrhage. Neurology.1994;44:815-820.