Introduction: Subarachnoid haemorrhage modulates a status of sympathetic stress, with elevated levels of circulant cathecolamines and secondary cardiac injury. ECG shows prolonged QT interval, negative T waves, ST segment depression and seldom ST segment elevation. We present a case of subarachnoid haemorrhage secondary to ruptured basilar artery aneurysm and inferior myocardial infarction with ST elevation, with conservative treatment.

Case presentation: A 63-year old male, with history of hypertension, old inferior myocardial infarction with stent implantation on the right coronary artery (2018) and basilar artery aneurysm diagnosed 1 week ago, comes in the emergency room with headache, nausea and speech impairment. CT reveals ruptured basilar artery aneurysm with subarachnoid haemorrhage at the basal cisterns level, in the sylvian fissures and in the frontal lobe. ECG shows ST elevation in inferior leads (right coronary artery), findings that occured in the ER and paroxistic atrial fibrillation. Echocardiography shows inferior septum hypokinesia, iv septum= 12 mm, mildly dilated left ventricle, EF= 50%, mild valvular regurgitations. Blood tests reveal normal myocardial enzymes, hs TnI= 64 ng/L. He is admitted in the intensive care wing with altered mental status, speech impairment and obnubilation, GCS= 13, BP= 120/70 mmHg, HR= 75 bpm. He does not go under neurosurgical interven-tion or coronary angiography because of high mortality risc due to comorbidities. The patient is treated conservatively, with favorable evolution with aneurysm thrombosis and normalisation of ECG abnormalities. The patient is discharged fully aware, cooperative, no motor deficit, GCS= 15.

Particularity of the case: T he patient has favorable evolution under conservative treatment, aneurysm thrombosis and normalisation of ECG abnormalities. The presence of ST elevation in inferior lead at the right coronary artery, where he suffered 2 years ago a myocardial infarction with stent implantation.