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J Emerg Med. 2012 Jan;42(1):28-35. doi: 10.1016/j.jemermed.2008.05.021. Epub 2008 Dec 4.

Effective myocardial salvage with percutaneous coronary intervention in late diagnosed acute post-traumatic ST-elevation myocardial infarction.

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  • 1First Cardiovascular Division, Chang Gung Memorial Hospital, Linkou, Taiwan.

Abstract

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.

CASE REPORT:

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.

CONCLUSION:

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.

Copyright © 2012 Elsevier Inc. All rights reserved.

PMID:
19062231
[PubMed - indexed for MEDLINE]
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