Subarachnoid hemorrhage

Introduction

Subarachnoid haemorrhage (SAH) is a neurological emergency with high mortality rates. 

Most common causes are rupture of aneurysm (congenital/infectious/traumatic) or rupture of arteriovenous malformation. 

Cardiac abnormalities are present in more than 50% of patients with SAH. 

Patients with SAH can have myocardial ischemia due to the increased level of circulating catecholamines or to autonomic stimulation from the brain.

ECG manifestation 

  • ST-segment elevations or depressions that can mimic acute myocardial infarction
  • widespread giant T wave inversions (“cerebral T waves”)
  • large U waves
  • prolonged QT interval
  • rhythm disturbances

ECG 1 Subarachnoid hemorrhage in a 40-year old patient 
             -  ST elevations mimicking STEMI/pericarditis (II, III, aVF, V1-V3)

References

  1. Chatterjee S. ECG Changes in Subarachnoid Haemorrhage: A Synopsis. Neth Heart J. 2011;19(1):31-34. doi:10.1007/s12471-010-0049-1
  2. https://www.ahajournals.org/doi/pdf/10.1161/01.STR.5.3.384
  3. https://pmj.bmj.com/content/postgradmedj/57/667/294.full.pdf