STEMI in a Patient With Recent Intracranial Hemorrhage

A 63-year-old male patient with a history of hypertension presented to the emergency department with a one-day history of dizziness, nausea, and vomiting. A computed tomography (CT) scan of the brain demonstrated the presence of an acute intracranial hemorrhage in the cerebellar vermis, which was urgently treated with coil embolization. He was thereafter admitted with plans for a sub-occipital craniotomy. During induction he became hypotensive, requiring vasoactive medications including epinephrine, phenylephrine, and ephedrine. Shortly after, ST segment elevations were noted on the telemetry monitor. This was followed by an electrocardiogram, which demonstrated ST segment elevation in the inferior leads with reciprocal changes (Figure).