ST-Elevation Myocardial Infarction in Patient with Subarachnoid Hemorrhage

Case Report

Austin J Clin Case Rep. 2023; 10(8): 1309.

ST-Elevation Myocardial Infarction in Patient with Subarachnoid Hemorrhage

Grabczewska Z¹; Serafin Z²; Sciesinski J²

¹Department of Cardiology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland

²Department of Radiology and Diagnostic Imaging, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland

*Corresponding author: Zofia Grabczewska Department of Cardiology, Antoni Jurasz University Hospital No. 1 ul. Marii Sklodowskiej-Curie 9, 85-094 Bydgoszcz Email: z.grabczewska@cm.umk.pl

Received: October 20, 2023 Accepted: November 13, 2023 Published: November 20, 2023

Abstract

We present the case of a 35-year-old man with ST-elevation lateral wall myocardial infarction and Subarachnoid Hemorrhage (SAH) from a ruptured aneurysm of the Anterior Cerebral Artery (ACA). Before the stroke was diagnosed, Electrocardiography (ECG) was performed, which showed changes characteristic of lateral wall ST-elevation myocardial infarction. Therefore, coronary angiography was carried out, revealing no stenotic lesions in the coronary arteries. Myocardial necrosis was confirmed by high troponin I levels and akinesia of lateral wall segments found in echocardiography examination. Once SAH was diagnosed, percutaneous embolization of the aneurysm was performed. Despite all the medical interventions undertaken, the patient died.

Key words: subarachnoid hemorrhage, myocardial infarction

Main Text

We present the case of a young man (J.J. 35 years old) who was admitted to the Cardiac Intensive Care Unit due to lateral wall myocardial infarction. His wife called for emergency medical services because he became unconscious, wheezed and vomited. The event took place during sexual intercourse. His wife, who was a nurse, put him in the recovery position, but choking could not be ruled out. The emergency medical team found him unconscious, with regular but fast heart rate and respiratory failure. He was intubated, excess secretions were removed from his airways by suctioning, and his breathing had to be helped by a ventilator. Because ECG showed lateral wall myocardial infarction (Figure 1a & 1b), the patient was transferred directly to the catheterization laboratory. A stomach tube was inserted and ASA 300 mg and clopidogrel 600 mg were administered. Also, 5000 U of heparin were used. Coronary angiography showed no stenotic lesions in the coronary arteries. The first measurement of high-sensitivity troponin I levels (hsTnI) was 1,300ng/L (normal value <35 ng/L). The second measurement, taken 3 hours later, was 13,000 ng/L. ECHO examination revealed akinesia of several segments of the left ventricle and significantly decreased Left Ventricular Ejection Fraction (LVEF), which was at 35%. Myocardial infarction was therefore determined. The patient was sedated using propofol because he was anxious and there were concerns about his intubation. The ECG performed just after coronary angiography revealed resolution of earlier changes (Figure 2). The next step was computed tomography of the head which showed an extensive subarachnoid hematoma (Figure 3). CT angiography revealed a ruptured aneurysm in the ACA region (Figure 4). Neurosurgical operation was risky because the patient received heparin and two antiplatelet drugs. A decision was made to embolize the aneurysm percutaneously. The patient was hemodynamically stable. The percutaneous embolization of the aneurysm was successfully performed. The patient was subsequently admitted to the Intensive Care Unit. However, in spite of all of the above mentioned interventions, his status worsened, as brain swelling increased. On the second day after admission, brain death was diagnosed and the patient was declared dead.