Severe intracranial bleeding mimicking acute inferior myocardial infarction with right ventricular involvement

Electrocardiographic (ECG) changes and wall motion abnormalities of the lef t ventricle have been observed in patients with severe intracranial hemorrh age. However, ECG evidence of an acute myocardial infarction in this settin g is extremely rare but may have important therapeutic consequences. We rep ort the case of a 45-year-old female who became unconscious with respirator y insufficiency after an endoscopic retrograde cholangiopancreaticoscopy wi th ECG changes consistent of an inferior myocardial infarction with right v entricular involvement. Immediate coronary angiography revealed normal coro naries; however, left ventricular angiography showed extensive wall motion abnormalities predominantly in the anteroseptal region. Immediate cranial c omputer tomography demonstrated massive intracranial bleeding. Intracranial hemorrhage can be associated in the initial phase with ECG evidence of an acute myocardial infarction. This has to be taken into consideration in the setting of unexplained loss of consciousness or nonresponsiveness of a pat ient. A rapid diagnostic evaluation has to be initiated to rule out a myoca rdial infarction and to diagnose intracranial hemorrhage before the use of thrombolytic or anticoagulant therapy. Copyright (C) 2001 S. Karger AG, Bas el.