When subarachnoid hemorrhage mimics
acute coronary syndrome in out-of-hospital
cardiac arrest: a diagnostic challenge

When subarachnoid hemorrhage mimics
acute coronary syndrome in out-of-hospital
cardiac arrest: a diagnostic challenge

Out-of-hospital cardiac arrest, Like subarachnoid hemorrhage, Acute coronary syndrome, Computed tomography

Abstract
Background Out-of-hospital cardiac arrest (OHCA) is most often due to acute coronary syndrome (ACS), but
less frequent causes like subarachnoid hemorrhage (SAH) may mimic cardiac disease through ECG changes and
biomarker elevation, risking misdiagnosis and inappropriate interventions. The aim of this case was to present a case
of a patient who experienced OHCA due to subarachnoid hemorrhage mimicking ACS leading to catastrophic results.
Case presentation A 42-year-old woman with no cardiovascular risk factors suffered sudden cardiac arrest during
exercise. Initial ECG and troponin levels suggested SCA, but coronary angiography was normal. Subsequent head
CT revealed a massive subarachnoid hemorrhage. Despite supportive care, the patient died on day 5 from cerebral
edema.
Conclusion SAH can cause cardiac arrest with ECG changes mimicking ACS, highlighting the importance of cranial
CT in comatose post–cardiac arrest patients.
Keywords Out-of-hospital cardiac arrest, Like subarachnoid hemorrhage, Acute coronary syndrome, Computed
tomography

Youssef Lahmouz1*, Jaouad Nguadi1
, Hanae EL Ghiati1
, Jihane Fagouri1
, Meryem Bennani1
, Abdelilah Ben EL Makki1
,
Jamal Kheyi1
, Hicham Bouzelmat1
, Zouhair Lakhal1
, Aatif Benyass1
and Ali Chaib1