American Journal of Medical Case Reports
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American Journal of Medical Case Reports. 2020, 8(10), 341-347
DOI: 10.12691/ajmcr-8-10-6
Open AccessCase Report

Subarachnoid Hemorrhage Presenting with Second-Degree Type I Sinoatrial Exit Block: A Case Report

Pramod Theetha Kariyanna1, Ruchi Yadav1, Vivek Yadav2, Samuel Apple1, Naseem A. Hossain1, Neema Jayachamarajapura Onkaramurthy3, Apoorva Jayarangaiah4, Ayesha Saad1 and Isabel M. McFarlane1,

1Division of Cardiovascular Disease and Department of Internal Medicine, State University of New York, Downstate Medical Center, Brooklyn, New York, USA

2Department of Internal Medicine, Brookdale University Hospital and Medical Center, 1 Brookdale Plaza, Brooklyn, New York- 11212, USA

3Department of Internal Medicine, Columbia College of Physicians and Surgeons, NYC Health and Hospitals/Harlem Hospital Center, New York 10037, USA

4Department of Internal Medicine, Albert Einstein College of Medicine, NYC Health and Hospitals/Jacobi Medical Center, Bronx, New York-10461, USA

Pub. Date: June 22, 2020

Cite this paper:
Pramod Theetha Kariyanna, Ruchi Yadav, Vivek Yadav, Samuel Apple, Naseem A. Hossain, Neema Jayachamarajapura Onkaramurthy, Apoorva Jayarangaiah, Ayesha Saad and Isabel M. McFarlane. Subarachnoid Hemorrhage Presenting with Second-Degree Type I Sinoatrial Exit Block: A Case Report. American Journal of Medical Case Reports. 2020; 8(10):341-347. doi: 10.12691/ajmcr-8-10-6


The understanding of neural regulation of the cardiovascular function and the implications of a “Heart-Brain Axis “has been a topic of interest for clinicians for many years. Electrocardiographic (ECG) and structural cardiac changes, ranging from mild, asymptomatic, transient alteration in cardiovascular function to severe, irreversible, and potentially life-threatening injury, can actually be a manifestation of several neurological disorders. When managing cardiac disorders, a high index of clinical suspicion, detailed history-taking and physical examination skills, and an extensive workup that covers both cardiac and non-cardiac causes should be utilized. It is important to consider that cardiovascular dysfunction of an underlying neurological etiology may lead to difficulty in diagnosing and optimizing treatment of the latter. We report the case of a middle-aged female with the chief complaint of syncope preceded by a headache with no focal neurological deficits, originally diagnosed with- and whose syncope was attributed to sinus bradycardia and type I sinoatrial (SA) exit block on ECG. Subsequently, when the patient became altered, however, computer tomography (CT) angiography revealed subarachnoid hemorrhage (SAH) with middle cerebral artery aneurysm. This presentation emphasizes the importance of tabulating neurological injury as one of the differential diagnoses while managing ECG changes in cardiovascular disease (CVD), as missing and delaying the former can result in disastrous consequences.

subarachnoid hemorrhage (SAH) electrocardiography (ECG) type 1 sinoatrial (SA) exit block syncope neurological injury heart brain axis

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