Background: Subarachnoid hemorrhage [SAH] is a neurological emergency with high mortality rates; Cardiac dysfunction with unfavorable neurological outcomes is common association.
The Aim of The Work: Subclinical left ventricular systolic dysfunction and its association with the outcome of SAH was assessed.
Patients and Methods: 120 cases were involved in this study divided in to two groups 60 healthy control group and 60 Patients with non-traumatic aneurysmal SAH. They were scaled according to Hunt & Hess scale and analyzed for age, sex, history of hypertension, diabetes mellitus, and smoking. ECG was done for all cases, Serum cholesterol, LDLc and troponin I were measured. Conventional and 2D speckle tracking echo were done for the following parameters, ejection fraction EF [by both M mode and biplane], LVEDD, LVESD, LVFS, RWMA and LV GLS.
Results: Female gender was more affected beside, significant increases hypertension, smoking, s. cholesterol, LDLc, and troponin I. ECG showed significant ST- T wave changes and prolongation in QTc . Conventional echocardiography showed no significant changes regarding EF, FS, LVEDD and LVESD while, there were significant RWMA in the form of anteroseptal hypokinesia. Strain imaging of LV showed significant reduction of LV GLS in SAH cases which indicates subclinical dysfunction. Hunt& Hess scaling showed about 28.3% of cases had 3 grades which indicated bad prognosis of these cases. Positive correlation between Hunt & Hess scale and hypertension, troponin I and LV GLS which confirms the association between myocardial damage and bad clinical outcome of SAH. 
Conclusion: Subclinical myocardial damage and dysfunction is common complication of SAH, which is associated with poor prognosis SAH.