Acute subarachnoid haemorrhage and the mysterious electrocardiogram

Abstract

 Subarachnoid haemorrhage (SAH) is a devastating neurological insult, and is increasingly understood as a multi-system condition initiated in the central nervous system. Perioperative investigation of patients presenting for aneurysm surgery often includes a routine electrocardiogram (ECG) which frequently reveals an abnormality. We describe a patient who presented with SAH and who was found to have significant Q waves on the ECG suggestive of a trans-mural myocardial infarction, despite a negative medical history for such an event. We brie­ y highlight the issues faced by the anaesthesiologist when dealing with the patient with SAH and ECG abnormality, and the implications for cardiovascular dysfunction