„Stroke–Heart“ syndrome resembling st-elevation myocardial infarction in the course of subarachnoid hemorrhage. A clinical case and literature review

Brain injury resulting from a vascular event may trigger a spectrum of cardiovascular disorders, including acute myocardial dysfunction, heart failure, myocardial infarction, life-threatening arrhythmias, and even sudden cardiac death. These events are encompassed by the term ‘Stroke-Heart’ syndrome, which is associated with an increased risk of mortality and incomplete neurological recovery compared with cases of stroke without cardiac complications. We present a clinical case of a 66-year-old female patient from Ukraine in whom aneurysmal subarachnoid hemorrhage was accompanied by a clinical presentation mimicking acute coronary syndrome, with dynamic ischemic-type ST-T changes, prolonged QT interval, and left ventricular systolic dysfunction. Elevated catecholamine levels and impaired autonomic regulation in subarachnoid hemorrhage may cause myocardial stunning and injury in the absence of coronary obstruction. This case highlights the need for thorough knowledge not only of the classical clinical presentation of focal neurological deficits but also of other possible pathophysiological manifestations along the cerebro-cardiac axis in order to support differential diagnostic reasoning and the definitive establishment of the correct diagnosis.