Electrocardiographic abnormalities mimicking myocardial infarction in a patient with intracranial haemorrhage: a possible pitfall for prehospital thrombolysis.
The electrocardiogram, when applied in the prehospital setting, has a significant effect on a patient with chest pain. The potential effect includes both diagnostic and therapeutic issues, including the diagnosis of acute myocardial infarction and the indication for thrombolysis or invasive procedures. We report the case of a man who suffered from a syncope, with a prehospital electrocardiogram showing prominent ST-segment elevation. Out-of-hospital thrombolytic therapy was planned by the emergency department. Fortunately, thrombolysis did not start because the patient fared worse. He was taken to the emergency department and, because of mental status impairment, it was decided to perform a cranial computed tomographic scan. The diagnosis shifted to a haemorrhagic stroke. According to the guidelines, prehospital thrombolysis would have been inappropriate in this case because the patient did not have any chest discomfort. The pathophysiological mechanisms of electrocardiographic abnormalities in the setting of intracranial haemorrhage are reviewed, as well as the issue of thrombolysis administered or planned only on the basis of an electrocardiogram.
Musuraca
Gerardo
G
Division of Cardiology, S. Maria del Carmine Hospital, Rovereto (TN), Italy. musuraca@yahoo.it
Imperadore
Ferdinando
F
Cemin
Claudio
C
Terraneo
Clotilde
C
Vaccarini
Chiara
C
De Girolamo
Pier Giuseppe
PG
Vergara
Giuseppe
G
D003937:Diagnosis, Differential; D004562:Electrocardiography; D004632:Emergency Medical Services; D017809:Fatal Outcome; D006801:Humans; D020300:Intracranial Hemorrhages / Q000175:diagnosis* / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000188:drug therapy; D015912:Thrombolytic Therapy / Q000706:statistics & numerical data; D014057:Tomography, X-Ray Computed