An unconscious patient with an electrocardiogram mimicking an acute myocardial infarct.

Accepted 10 March 1998 A 72-year-old woman was admitted to the emergency room for sudden loss of consciousness preceded by headache without tonic-clonic movements, urine loss, or tongue bite. There was no history of trauma. Her medical history was unrevealing: she had presented with bronchopneumonia in 1953, and she had been operated for a strangled hernia in 1968 and for an ovarian cyst in 1983. She had no cardiovascular risk factors and took no medications. On admission, blood pressure was 110/85 mmHg, pulse was equal and regular at 80 beats/min. She had no fever and there was no sign of shock. Heart sounds were normal and no vascular bruit was detected. Lungs were clear. She was unconscious and showed extension (decerebrate) posturing to painful stimuli. The rest of the neurologic examination was normal. Chest X-ray was unremarkable. Haemogram, renal function, electrolytes, cardiac enzymes, liver function tests and arterial blood gases were in the normal range. Glucose was 7.85 mmol/l (1.42 g/l). Ophthalmologic examination revealed normal papillae. Her admission electrocardiogram (ECG) showed a regular sinus rhythm, a normal atrioventricular conduction of 160 ms, a Q wave and a ST segment elevation from V2 to V6 (figure 1).