A Case of Acute Myocardial Infarction after Blunt Chest Trauma in a Young Man

Abstract

Coronary artery injury rarely occurs after blunt chest trauma, but it can lead to extensive myocardial infarction and be frequently overlooked. A 16-yr-old man was presented with comatose mental state and rapid respiration rate. He ran into guard rail while riding a motorcycle. In routine examination, his electrocardiogram showed Q wave and 2 mm ST segment elevation in all precordial leads, I and aVL. The cardiac enzymes were also elevated: creatine kinase (CK)-MB was 300 U/L, and cardiac specific troponin I was 5.7 ng/mL. Two-dimensional echocardiography showed anteroseptal akinesia with severely depressed left ventricular function, ejection fraction of 28%. He could not receive any anticoagulation or thrombolytic therapy because of his brain lesion. Three weeks later, his mental state improved. A diagnostic coronary angiogram revealed total occlusion in the proximal left anterior descending artery (LAD) with collaterals from the right coronary artery and left circumflex artery. We successfully performed a percutaneous coronary intervention for the LAD lesion, and the final angiogram showed a good coronary flow without residual stenosis.

Trauma associated with acute myocardial infarction in a multi-state hospitalized population

“…Evidence from numerous case studies suggests that trauma is one of the nonatherosclerotic factors that associated with AMI particularly among young people (45 years old or younger) [2][3][4][5][6][7][8][9][10][11][12]. Among older individuals (older than 46 years), coexisting atherosclerosis or preexisting atheromatous plaque may contribute to the appearance of AMI following a traumatic episode [6].…”

Preparing reports in cases with blunt trauma to the heart area: Three cases

“…In a study by Park et al, it was found that in a 16-year-old male patient who had chest trauma by hitting the handrails while riding a motorcycle, ST elevation was found in ECG, an increase was found in cardiac enzymes and the left ventricular function was suppressed. In the diagnostic coronary angiography performed three weeks later, a complete occlusion including collaterals in the proximal left anterior descending artery (LAD) right coronary artery and left circumflex artery, and percutaneous coronary intervention was applied to the LAD lesion [20]. In another case report, a 37-year-old male with severe mental retardation was evaluated in the emergency service he presented with a complaint of substernal chest pain after physical assault to his head, face and chest area.…”

Acute ST‐elevation myocardial infarction in a 24‐year‐old woman with atheromatous coronary artery disease

“…Various systemic conditions have also been shown to predispose to myocardial infarction, including pregnancy, 5 inflammatory bowel disease 6 and streptococcal infection 7 . The pathophysiology of these non‐atheromatous infarctions may include coronary vasospasm, arteritis, myocarditis, abnormalities of platelet aggregation, endothelial dysfunction and, particularly in the case of trauma, intimal tears, haemorrhage and thrombosis 8 . The role of genetic variance in the aetiology of atypical myocardial infarctions is complex and as yet incompletely understood.…”