Images in Clinical Medicine

Electrocardiographic Changes in Intracranial Hemorrhage Mimicking Myocardial Infarction

W. Brian Bailey, M.D., and Bernard R. Chaitman, M.D.

N Engl J Med 2003; 349:561August 7, 2003

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A 19-year-old man was admitted to the trauma unit after being struck in the left temple by a brick. Surgery to evacuate an intracranial hemorrhage was performed, and an electrocardiogram (ECG) was recorded 48 hours later, after a transient episode of hypoxemia. The tracing showed marked ST-segment elevation in leads II, III, aVF, and V₆ accompanied by ST-segment depression and inverted T waves in leads V₃ to V₅, mimicking the changes seen in acute myocardial ischemia. The QT interval was markedly prolonged. Serial measurements of cardiac-enzyme levels and an echocardiogram were normal. The next morning, the patient's ECG showed less severe ST-segment deviation. This case illustrates the marked ECG changes that are occasionally seen with intracranial hemorrhage and that can lead to an erroneous diagnosis of acute myocardial ischemia.

W. Brian Bailey, M.D.
Bernard R. Chaitman, M.D.
Saint Louis University School of Medicine, St. Louis, MO 63110-0250

Citing Articles (4)

Citing Articles

1. 1

   Kenan Iltumur, Yusuf Tamam, Zulkuf Karahan, Aslan Guzel, Rojhat Altındag. (2007) Coexisting subarachnoid hemorrhage and subdural hematoma mimicking acute anterolateral myocardial infarction. Journal of Electrocardiology 40:5, 422-425
   CrossRef

2. 2

   Gerardo Musuraca, Ferdinando Imperadore, Claudio Cemin, Clotilde Terraneo, Chiara Vaccarini, Pier Giuseppe De Girolamo, Giuseppe Vergara. (2006) Electrocardiographic abnormalities mimicking myocardial infarction in a patient with intracranial haemorrhage: a possible pitfall for prehospital thrombolysis. Journal of Cardiovascular Medicine 7:6, 434-437
   CrossRef

3. 3

   E. P. Hess, E. T. Boie, R. D. White. (2005) Survival of a Neurologically Intact Patient With Subarachnoid Hemorrhage and Cardiopulmonary Arrest. Mayo Clinic Proceedings 80:8, 1073-1076
   CrossRef

4. 4

   (2003) Electrocardiographic Changes in Intracranial Hemorrhage Mimicking Myocardial Infarction. New England Journal of Medicine 349:19, 1874-1875
   Full Text

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