An 88-year-old female with a history of hypertension, dyslipidaemia and hypothyroidism but without known pre-existing heart disease arrived at the primary care emergency services with sudden confusion and agitation. On admission, electrocardiography (ECG) showed sinus rhythm (SR) with bizarre and distorted T waves associated with a prolonged QTc interval (589 ms) in leads V2–V6 (Fig. 1a). She was transferred to hospital, and ECG was repeated 2 h later, which showed a different pattern: SR and prolonged QTc interval without the previous ST-T changes (Fig. 1b). Cerebral computed tomography (CT) imaging identified an ischaemic area in the right temporal-occipital-parietal cortex (Fig. 1c). The patient was discharged after 7 days, with moderate mental confusion.
Fig. 1
Electrocardiogram at a primary care emergency services and b hospital admission. c CT scan, at hospital admission, showing ischaemic area in right temporal-occipital-parietal cortex
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Ischaemic strokes may be associated with ECG changes such as prolonged QT interval, ST-segment depression, T wave inversion or abnormal U waves. The precise mechanism has not yet been identified, but changes are usually transient [1]. There is a lack of evidence for prehospital ECG changes in acute stroke patients [2]. Recognition of this unusual pattern may point to a differential non-cardiac diagnosis and prevent delay in clinical decision-making and early treatment.
Conflict of interest
C. Soares, M. Temtem, A. Sá and R. Rodrigues declare that they have no competing interests.
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