Effective myocardial salvage with percutaneous coronary intervention in late diagnosed acute post-traumatic ST-elevation myocardial infarction.
BACKGROUND
Acute post-traumatic ST-elevation myocardial infarction (STEMI) is rare but potentially disastrous in patients with blunt cardiac injury. Sometimes the diagnosis is delayed. Failed myocardial salvage by percutaneous coronary intervention (PCI) within 9 h after the onset of post-traumatic STEMI has been described.


OBJECTIVE
We present a case report of a patient in whom effective myocardial salvage with PCI was obtained in a late diagnosed acute post-traumatic STEMI.


METHODS
We report the case of a young man who was involved in a motorcycle crash, who had a delayed diagnosis of post-traumatic STEMI. Diagnostic coronary angiography was performed to guide treatment strategy. An occluded left anterior descending artery due to a dissection, and an intimal flap at the first diagonal branch were found. A PCI was done 18 h after the onset of the event with striking and immediate improvement of the regional left ventricular wall motion and ejection fraction.


CONCLUSIONS
After blunt thoracic injury, there is the possibility of an acute post-traumatic STEMI being present when facing a patient with clues of blunt cardiac injury. If the diagnosis of acute post-traumatic STEMI is clinically strong, the patient should be managed individually according to the clinical scenario. Early recognition and prompt management are vital when dealing with patients suffering post-traumatic STEMI.
Lin
Yen-Chen
YC
First Cardiovascular Division, Chang Gung Memorial Hospital, Linkou, Taiwan.
Chang
Yu-Sheng
YS
Chen
Ming-Shyan
MS
Ho
Wan-Jing
WJ
Kuo
Chi-Tai
CT
Chang
Chi-Jen
CJ
D000208:Acute Disease; D000328:Adult; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D057210:Delayed Diagnosis; D004562:Electrocardiography; D004636:Emergency Service, Hospital; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000175:diagnosis / Q000628:therapy*; D016879:Salvage Therapy / Q000379:methods; D016896:Treatment Outcome