Scenario: This 12-lead electrocardiogram (ECG) was obtained in the emergency department (ED) from a previously healthy 56-year-old female found unresponsive at home. During transport she had a seizure followed by a cardiac arrest, but was successfully resuscitated. While in the ED, she had another seizure and became bradycardic with agonal respirations and was consequently intubated.

Sinus tachycardia, QTc prolongation, diffuse ST segment elevation and other nonspecific repolarization abnormalities (J waves in V5 and camel-hump pattern in lead I). These ECG abnormalities, combined with the clinical presentation, are suggestive of the profound repolarization abnormalities seen in brain injury or hypothermia patients. An urgent head computed tomography (CT) scan showed a diffuse subarachnoid hemorrhage (SAH) with intraventricular extension. Clinicians should interpret the above ECG patterns with caution so not to confuse ST-segment changes during neurologic injury with acute myocardial infarction.

ECG changes following SAH can be mediated by intense central...

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