Abstract

HISTORY AND CLINICAL FINDING:

A 32-year-old man came to the surgical department because of persisting retrosternal pain radiating to the left side of the thorax for two days. During a move an armchair had slipped out of his hands and caused a mild blunt chest trauma. The further clinical examination findings were unremarkable.

INVESTIGATIONS:

Echocardiography was performed to rule out myocardial contusion. It showed a slightly reduced left-ventricular ejection fraction (EF 52 %) with akinesia of all apical segments overlapping to the septal and anterolateral wall, reaching the mid-ventricular area. The electrocardiogram (ECG) revealed a complete loss of R voltage of the anterior wall with persisting ST elevations in V4-V6.  Coronary angiography showed a short-length thrombotic occlusion of the left anterior descending artery (LAD) immediately after giving off the diagonal branch, based on a plaque-rupture.

TREATMENT AND COURSE:

Because of the subacute myocardial infarction in combination with a bifurcation problem a drug-eluting stent was inserted in accordance with current studies. Initial cardiac MRT showed slightly reduced left-ventricular ejection fraction (EF 50 %), while myocardial wall thickness was preserved in all segments. Four weeks later severe myocardial remodeling had caused transmural scar formation of the anterior wall which had resulted in a reduction of left-ventricular EF to 39 %.

CONCLUSION:

Myocardial infarction based on plaque-rupture can occur after a mild blunt chest trauma even in young patients. An early cardiological examination, at least an ECG, should be performed to avoid complications of mild, painful blunt chest trauma.

© Georg Thieme Verlag KG Stuttgart · New York.