Cardiovascular Complications of SAH: Neurogenic Stunned Myocardium in Subarachnoid Haemorrhage

Abstract

A 56-year-old female was brought to our emergency department (ED) after loss of consciousness at home preceded by chest pain and headache. In the ED, she showed the whole spectrum of neurocardiogenic effects in subarachnoid haemorrhage: electrocardiographic changes, regional wall motion abnormalities, and a rise of cardiac enzymes. Coronary angiography revealed normal coronary arteries. Echocardiography showed left ventricular basal hypokinesis and left ventricular dysfunction. Subsequently, cerebral computed tomography reported a diffuse subarachnoid haemorrhage due to a ruptured intracranial aneurysm. After her admission in the ICU, she developed cardiogenic shock and pulmonary oedema. Her aneurysm was obliterated with endovascular treatment. There were no intracranial complications, and the cardiovascular abnormalities resolved during her stay in the ICU. At discharge, both the echocardiography and the electrocardiogram were normal.

This case highlights the possibility of an acute cerebrovascular disease, especially related to subarachnoid haemorrhage, as an underlying cause of cardiac abnormalities mimicking myocardial ischemia and the impact of these cardiovascular abnormalities in the clinical course and outcome.