Complete heart block as the presenting feature in subarachnoid haemorrhage

Abstract

Cardiac manifestations of subarachnoid haemorrhage (SAH) are well-documented phenomena that can complicate the treatment of this devastating condition. Here, we present a case of SAH presenting as complete heart block on initial assessment, an extremely rare event.A 53-year-old woman presented with a witnessed fall, sustaining a mild head injury. She denied any symptoms of SAH. Initial ECG revealed complete heart block, for which the patient was accepted under the cardiology team. For completion, a CT head scan was requested, this demonstrated significant SAH blood load in an aneurysmal rather than traumatic pattern. CT angiogram and subsequent digital subtraction angiography confirmed a posterior communicating artery aneurysm as the cause of the SAH. This case highlights the importance of considering neurological diagnoses in patients with collapse even with concomitant cardiac abnormalities, as the two are often inextricably linked.

Changes in Electrocardiogram in Patients With Spontaneous Subarachnoid Hemorrhage: A Cross-Sectional Study

“…Human subjects: Consent was obtained or waived by all participants in this study. Institutional Review Committee, Institute of Medicine (IOM), Tribhuvan University issued approval 501 (6)(7)(8)(9)(10)(11)E2. The research proposal was submitted to and approved by the Institutional Review Committee (IRC) of the Institute of Medicine (IOM), Tribhuvan University on April 20, 2023.…”

“…In previous large-sample studies, commonly detected abnormalities were large U wave, T wave abnormality, QTc prolongation, high R wave, ST depression, and bradycardia [ 4 , 5 ]. There have also been reports of cases where SAH has presented as a complete heart block and transient ST elevated myocardial infarction [ 6 , 7 ]. Some studies have tried to evaluate the significance of such ECG changes and there is evidence that the electrocardiographic abnormalities, especially abnormal Q or QS wave and nonspecific ST, T changes, may predict the development of neurogenic pulmonary edema within 24 hours in adult patients with spontaneous SAH [ 8 ].…”