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Sometimes cardiac troponin elevation may accompany ECG changes in aneurysmal subarachnoid hemorrhage. It was found that cardiac injury was incrementally worse with increasing severity of aneurysmal subarachnoid hemorrhage and was associated with persistent prolongation of QTc and ventricular arrhythmias. 2009 Nov;40(11):3478-84.
Look for Vascular Etiology -- think of these while doing H and P: --Bleeding: ruptured AAA, GI bleed, ruptured ectopic pregnancy, other spontaneous bleed such as mesenteric aneurysms. Abnormal Electrocardiogram (ECG): Defined (San Fran syncope rule) as any new changes when compared to the last ECG or presence of non-sinus rhythm.
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