Listening to the head and not the heart: subarachnoid haemorrhage associated with severe acute left ventricular failure

Abstract

Headache is a very common presenting symptom in the emergency department, and distinguishing subarachnoid haemorrhage from more benign causes of headache can be challenging. This particular presentation of subarachnoid haemorrhage was made more difficult by concurrent-related cardiac pathophysiology. This case report describes the evolving differential diagnosis of a 54-year-old woman initially presenting with headache and confusion, with signs and investigations suggestive of ST elevation myocardial infarction and resultant left ventricular failure. The importance of prompt primary percutaenous coronary intervention left clinicians with a difficult decision about which specialty was most appropriate for the patient to be transferred to. Ultimately the symptoms were explained by radiographic confirmation of subarachnoid haemorrhage and subsequent adrenergic storm, causing myocyte injury and myocardial contractile dysfunction. This patient was transferred for coiling of a ruptured cerebral artery berry aneurysm. Her left ventricular failure improved from severe to mild within 48 h of presentation.

The Harmful Effects of Subarachnoid Hemorrhage on Extracerebral Organs

“…Approximately 10% of all SAH patients suffer from LV systolic dysfunction [ 68 ]. A 54-year-old woman initially presented with ST elevation myocardial infarction and resultant LV failure, which was ultimately explained by the diagnosis of SAH with subsequent adrenergic storm [ 75 ]. Systolic dysfunction can be observed by echocardiography as a reduced LV ejection fraction and/or the presence of regional wall motion abnormalities of the LV.…”

Insights into subarachnoid hemorrhage: A comprehensive case series analysis

“…The overall global incidence of aneurysmal SAH is 6.1/100000 person years. This life-threatening condition occurs when blood escapes from the vessels into the subarachnoid space, the region between the arachnoid membrane, and the pia mater surrounding the brain [1]. The most common cause of SAH is the rupture of intracranial aneurysms, although other etiologies such as arteriovenous malformations (AVM) and trauma can also lead to this devastating event.…”