ST-Elevation Myocardial Infarction after Penetrating Thoracic Trauma.
BACKGROUND
ST-segment elevation myocardial infarction (STEMI) may complicate penetrating thoracic trauma.


METHODS
This report describes a 42-year-old man who sustained a self-inflicted gunshot wound to the left chest. Electrocardiogram showed ST elevation in the inferior leads. Emergent catheterization was not recommended and conservative management was initiated. Cardiac catheterization 4 days later showed no perturbation of the coronary arteries, neither atherosclerotic nor traumatic. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case is unusual because it demonstrates a STEMI with no detectable plaque rupture or gunshot pellets on coronary catheterization. The decision to aggressively manage these patients with early coronary angiography depends on the hemodynamic status of the patient, their cardiac risk factors, and their ability to tolerate ischemic insult. In asymptomatic hemodynamically stable patients, conservative medical management should be considered. Myocardial infarction is a complication after penetrating thoracic trauma and should be considered in initial evaluation.
Department of Emergency Medicine, University of Louisville, Louisville, Kentucky.
Kiran
K
Faryar
Department of Medicine, Physiology, & Biophysics; Adult Structural Heart Disease; and Research - Interventional Cardiology, Division of Cardiovascular Medicine, University of Louisville, Louisville, Kentucky.
Michael P
MP
Flaherty
Department of Emergency Medicine, University of Louisville, Louisville, Kentucky.
Martin
M
Huecker
D000328:Adult; D006328:Cardiac Catheterization / Q000379:methods; D004562:Electrocardiography / Q000379:methods; D004636:Emergency Service, Hospital / Q000458:organization & administration; D006801:Humans; D008297:Male; D000072657:ST Elevation Myocardial Infarction / Q000175:diagnosis / Q000209:etiology*; D013406:Suicide, Attempted / Q000523:psychology; D013898:Thoracic Injuries / Q000150:complications*; D014948:Wounds, Gunshot / Q000150:complications* / Q000523:psychology
ST-segment elevation; gunshot wound; infarction; penetrating trauma