ST-segment elevation after blunt chest trauma: myocardial contusion with normal coronary arteries or myocardial infarction following coronary lesions

Abstract

Cardiac lesions secondary to blunt chest trauma vary from insignificant arrhythmias to fatal cardiac rupture. Of these, a distinction remains difficult; face to ST-segment elevation on ECG with positive cardiac biomarkers, is it a myocardial contusion or a genuine myocardial infarction (MI) secondary to coronary lesions? We report the case of a patient admitted for multiple trauma. Initial assessment showed an ST segment elevation on ECG, along with multiple fractures and abdominal injuries. We would like to discuss, through this case, the similarities and the differences between myocardial infarction due to coronary lesions and myocardial contusion in a traumatic context, but also emphasize the difficulty of striking the right balance between thrombotic and bleeding risks in this situation, and insist on the importance of a multidisciplinary and collegial reflexion so we can offer these patients the best care there is.

Traumatic blunt cardiac injuries: An updated narrative review

“…The only concern is the inability to distinguish between ST-segment changes due to a myocardial contusion or genuine myocardial infarction secondary to coronary lesion in the setting of BCI. [29] However, there is always a need for repetition of ECG in trauma settings and having a look at the prior ECG traces, if available, to determine whether the bundle branch block is new or old.…”

Influência individual dos fatores de risco cardiovasculares associados à angina em pacientes submetidos a teste ergométrico em um município do sul de Minas Gerais, Brasil

“…6 Contribui também para o desenvolvimento da placa aterosclerótica, e a proliferação e o crescimento das células musculares lisas, que podem ser estimuladas pela hipertensão por meio da angiotensina II. 7 Dentre esse grupo, o infarto agudo do miocárdio (IAM) é especialmente indicado para o desenvolvimento de indicadores e padrões de qualidade, considerando-se o impacto na mortalidade, a letalidade hospitalar, o volume de internações que acarreta e a sensibilidade a tecnologias médicas hospitalares. O IAM é um evento agudo que requer internação hospitalar, tendo um diagnóstico clínico relativamente simples e bem estabelecido, geralmente baseado no tripé história clínica, evolução eletrocardiográfica e curva enzimática.…”