We admitted a 42 year old woman with clinical signs of shock, coma, and ecg changes consistent with a ST elevation myocardial infarction to percutaneous coronary intervention. Normal coronary arteries were found. Due to the comatose state a cranial computed tomography scan was performed, where a subarachnoid hemorrhage was detected. We discuss the difficulty of diagnosing a subarachnoid hemorrhage, the pathophysiological cause of cardiac damage and ecg changes in acute neurological disease, and the differential diagnosis of ST elevation in the ecg.
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