Subarachnoid hemorrhage presenting as cardiac arrest mimicking acute myocardial infarction due to multivessel coronary vasospasm: a case report.

A 58-year-old man presented with out-of-hospital cardiac arrest. The initial rhythm was pulseless electrical activity, which deteriorated into ventricular fibrillation during resuscitation. After return of spontaneous circulation, electrocardiography demonstrated diffuse ST-segment depression with ST-segment elevation in lead aVR, strongly suggesting acute coronary syndrome. Emergent coronary angiography revealed simultaneous angiographic occlusion with TIMI 0 flow in the ostial left anterior descending artery and distal right coronary artery. During preparation for percutaneous coronary intervention, coronary flow spontaneously recovered to TIMI 3 without balloon dilation, stenting, or intracoronary vasodilator administration. Intravascular ultrasound demonstrated no plaque rupture or thrombus. Persistent coma prompted neuroimaging, which revealed diffuse subarachnoid hemorrhage with hydrocephalus. Although cardiac arrest associated with subarachnoid hemorrhage usually presents with non-shockable rhythms, this case demonstrated recurrent ventricular fibrillation and transient multivessel coronary occlusion closely mimicking acute myocardial infarction.