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      Severe Intracranial Bleeding Mimicking Acute Inferior Myocardial Infarction with Right Ventricular Involvement

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          Electrocardiographic (ECG) changes and wall motion abnormalities of the left ventricle have been observed in patients with severe intracranial hemorrhage. However, ECG evidence of an acute myocardial infarction in this setting is extremely rare but may have important therapeutic consequences. We report the case of a 45-year-old female who became unconscious with respiratory insufficiency after an endoscopic retrograde cholangiopancreaticoscopy with ECG changes consistent of an inferior myocardial infarction with right ventricular involvement. Immediate coronary angiography revealed normal coronaries; however, left ventricular angiography showed extensive wall motion abnormalities predominantly in the anteroseptal region. Immediate cranial computer tomography demonstrated massive intracranial bleeding. Intracranial hemorrhage can be associated in the initial phase with ECG evidence of an acute myocardial infarction. This has to be taken into consideration in the setting of unexplained loss of consciousness or nonresponsiveness of a patient. A rapid diagnostic evaluation has to be initiated to rule out a myocardial infarction and to diagnose intracranial hemorrhage before the use of thrombolytic or anticoagulant therapy.

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          The Use of Cardiac Troponin-I (cTnI) to Determine the Incidence of Myocardial Ischemia and Injury in Patients with Aneurysmal and Presumed Aneurysmal Subarachnoid Hemorrhage


            Author and article information

            S. Karger AG
            May 2001
            25 May 2001
            : 95
            : 1
            : 48-50
            aDivision of Cardiology, Department of Medicine and bDepartment of Neurosurgery, Johann Wolfgang Goethe University, Frankfurt am Main, Germany
            47343 Cardiology 2001;95:48–50
            © 2001 S. Karger AG, Basel

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            Figures: 2, References: 8, Pages: 3
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