The medical literature is replete with many case reports and reviews of nonpenetrating chest trauma causing cardiac injury. Most reports are based on autopsy data and discuss rupture of various portions of the heart or great vessels. The wide variety of injuries include a) pericardial injury, b) myocardial injury (contusion, lacerations or rupture), c) coronary artery injuries, d) valvular injuries, e) disturbances of rhythm or conduction and f) great vessel injury.i 1 Non fatal instances of myocardial or coronary artery injury directly caused by trauma that do not require reparative surgery are most difficult to document because of the possibility of pre-existing arteriosclerotic disease. We present here a unique case in that the cardiovascular status of this patient was documented to be normal prior to his injury and therefore it can be concluded that the new electrocardiographic changes shortly after the accident can be attributed to the chest trauma.
CASE REPORTThis 46 year old Caucasian male was well until October 21, 1970, when he was involved in a head on automobile accident. He stated that he was the driver of the automobile and wearing both a shoulder and a lap belt, and that at the time of the accident he was thrown forward, tearing both the belts and striking his chest on the steering wheel. He was admitted to St. Joseph's Hospital, Syracuse, New York, on the above date for treatment of extensive facial lacerations, fracture of the right s:xth rib, bruises to the right knee and right arm, costochondral fracture second and third left interspaces with overlying ecchymosis, and multiple chest contusions.During his six day hospitalization, electrocardiograms revealed left anterior hemiblock and non-specific ST-T abnormalities (Fig. 1). This left anterior hemiblock was a new finding as compared to an electrocardiogram taken on July 29, 1970, for a routine Naval Reserve examination (Fig. 2). Throughout his hospitalization he had no cardiac complaints and repeated cardiac examinations were unremarkable. While in the hospital his SGOT ranged from 48 on admission to 32 at discharge and his LDH ranged from 330 on admission to 390 on discharge. (Normal up to 100).He recuperated from his injuries and was seen by his physician on numerous occasions without ever complaining of chest pain, dyspnea, orthopnea, edema, palpitations or decrease in exercise tolerance.On July 12, 1971, he was seen as an outpatient at which time he again offered no cardiac complaints and stated that his exercise tolerance was excellent.at University of Sussex Library on June 4, 2016 ang.sagepub.com Downloaded from