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Complete heart block as the presenting feature in subarachnoid haemorrhage
  1. Joshua Pepper,
  2. Ciara Fenton,
  3. Howard Brydon
  1. Department of Neurosurgery, University Hospital of North Staffordshire NHS Trust, Stoke-on-Trent, UK
  1. Correspondence to Mr Joshua Pepper, pepper_joshua{at}


Cardiac manifestations of subarachnoid haemorrhage (SAH) are well-documented phenomena that can complicate the treatment of this devastating condition. Here, we present a case of SAH presenting as complete heart block on initial assessment, an extremely rare event.

A 53-year-old woman presented with a witnessed fall, sustaining a mild head injury. She denied any symptoms of SAH. Initial ECG revealed complete heart block, for which the patient was accepted under the cardiology team. For completion, a CT head scan was requested, this demonstrated significant SAH blood load in an aneurysmal rather than traumatic pattern. CT angiogram and subsequent digital subtraction angiography confirmed a posterior communicating artery aneurysm as the cause of the SAH. This case highlights the importance of considering neurological diagnoses in patients with collapse even with concomitant cardiac abnormalities, as the two are often inextricably linked.

  • arrhythmias
  • stroke
  • neurology
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  • Contributors JP selected the case, wrote the case report with CF, corrected the drafts and additional write-up, revised the manuscript as per reviewer’s comments and provided a point-by-point response to reviewers. CF wrote the manuscript draft under guidance and researched the paper. HB corrected the drafts, gave final approval and provided support with background research.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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