Dynamic ECG changes in a patient with subarachnoid haemorrhage

Acute cerebro-vascular disorders (ACVD) such as subarachnoid haemorrhage (SAH) increase sympathetic activity and a-adrenergic stimulation. Pathologic a-adrenergic stimulation can provoke several electrocardiogram (ECG) changes including ST-segment depression, wide, broad T-waves, U-waves merging into the T-waves, and QTc prolongation. Previous reports have shown that J-waves can appear in patients with ACVD and a brain injury [1–3]. J-wave is a deflection occurring at the J-point described by Osborn and called ‘the injury current’ in experimental models of hypothermia in dogs [4]. In addition to hypothermic patients, the J-wave can be observed in hypercalcaemia and arrythmogenic disorders such as in patients with idiopathic ventricular fibrillation (VF) who usually depict the so-called ‘Haissaguerre pattern’ [5, 6]. We previously reported the case of patient with SAH and a prominent J-wave associated with VF [7]. The aim of this presentation is to report an unusual ECG presentation in a patient with SAH. We present the case of a 36-year-old man with recent SAH. He was admitted to the ER because of persistent and ‘in-crescendo’ headache. ECG on admission showed sinus rhythm at 60 bpm, PQ interval of 180 ms, QTc of 480 ms,