CASE REPORT

Neurological Sciences

, Volume 22, Issue 5, pp 395-397

Headache as a manifestation of fatal myocardial infarction

  • J. AuerAffiliated withDepartment of Internal Medicine, Division of Cardiology and Intensive Care, General Hospital Wels, Grieskirchnerstrasse 42, A-4600 Wels, Austria
  • , R. BerentAffiliated withDepartment of Internal Medicine, Division of Cardiology and Intensive Care, General Hospital Wels, Grieskirchnerstrasse 42, A-4600 Wels, Austria
  • , E. LassnigAffiliated withDepartment of Internal Medicine, Division of Cardiology and Intensive Care, General Hospital Wels, Grieskirchnerstrasse 42, A-4600 Wels, Austria
  • , B. EberAffiliated withDepartment of Internal Medicine, Division of Cardiology and Intensive Care, General Hospital Wels, Grieskirchnerstrasse 42, A-4600 Wels, Austria

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Abstract

Cardiac ischemia typically causes chest pain, variously radiating elsewhere. Convergence of cardiac nerve fibers on central pathways receiving somatic afferents from the head is likely to be responsible for the perception of cardiac ischemic pain as headache. A 47-year-old man was admitted to the emergency room of our hospital with a 2-hour history of occipital headache. Routine electrocardiography revealed monophasic ST-segment elevation in leads I and aVL and ST-segment depression in leads II, III, and aVF. During recording of lead V1, ventricular fibrillation occurred. Advanced life support was started immediately but failed to restore rhythm and cardiac function. Autopsy showed two-vessel disease with a ruptured plaque and total thrombotic occlusion of the proximal left anterior descending artery and 80% stenosis of the right coronary artery. In this patient, headache was the only symptom of myocardial ischemia. Anatomic convergence of cardiac nerve fibers on central pathways receiving somatic afferents from the head is likely to be responsible for the perception of cardiac ischemic pain as headache. Owing to the very rare occurrence of headache as a symptom of myocardial ischemia, diagnosis is difficult and requires a high degree of suspicion.

Key words Myocardial ischemia Headache Myocardial infarction Cardiac ischemic pain Coronary artery disease Cardiac nerve fibers