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Andreenko EY, Yavelov IS, Loukianov ММ, Vernohaeva AN, Drapkina OM, Boytsov SA. Ischemic Heart Disease in Subjects of Young Age: Current State of the Problem. Features of Etiology, Clinical Manifestation and Prognosis. ACTA ACUST UNITED AC 2018; 58:24-34. [PMID: 30625075 DOI: 10.18087/cardio.2018.11.10195] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Accepted: 11/24/2018] [Indexed: 11/18/2022]
Abstract
In addition to conventional risk factors in young patients with ischemic heart disease (IHD) numerous other risk factors including genetics play an important role in its causation. Molecular genetic testing is recommended for the detection of monogenic diseases with a high risk of developing IHD, such as familial hypercholesterolemia. In majority ofyoung patients, the first manifestation of IHD is an acute coronary syndrome. Young patients with IHD more often have normal coronary arteries or single-vessel coronary disease, and in up to 20% of them cause of myocardial ischemia is not related to atherosclerosis. In general, young patients with IHD have better prognosis. However, there are sex differences in IHD outcomes the prognosis of patients with premature IHD and reason for this is still unclear.
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Affiliation(s)
- E Yu Andreenko
- National Medical Research Center for Preventive Medicine.
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2
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Guldner GT, Schilling TD. Coronary artery occlusion following blunt chest trauma: a case report and review of the literature. CAN J EMERG MED 2015; 7:118-23. [PMID: 17355662 DOI: 10.1017/s1481803500013087] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
ABSTRACTBlunt chest trauma causing coronary artery occlusion and myocardial infarction is a rare but potentially fatal condition. We present the case of a healthy 29-year-old man who developed a myocardial infarction due to complete occlusion of the proximal right coronary artery following blunt chest trauma. A review of the literature found 63 cases of previously healthy patients under 40 years of age who developed coronary artery occlusion following blunt chest trauma; diagnosis in all cases had been proven by angiography or during autopsy. The presentation, results of electrocardiography and echocardiography and laboratory findings of these patients are described.
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Affiliation(s)
- Gregory T Guldner
- Department of Emergency Medicine, Loma Linda University Medical Center, Loma Linda, California 92354, USA.
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3
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Wilson RF. Coronary Angiography. Coron Artery Dis 2015. [DOI: 10.1007/978-1-4471-2828-1_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Patil RR, Mane D, Jariwala P. Acute myocardial infarction following blunt chest trauma with intracranial bleed: a rare case report. Indian Heart J 2013; 65:311-4. [PMID: 23809387 DOI: 10.1016/j.ihj.2013.04.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Revised: 01/03/2013] [Accepted: 04/03/2013] [Indexed: 10/27/2022] Open
Abstract
A young male following road traffic accident (RTA) with head injury and parietal bleed was diagnosed with STEMI based on ECG findings which is rare occurrence. Coronary angiography showed thrombotic ostial occlusion of LAD. Successful primary angioplasty using thrombo-aspiration was done, in difficult clinical scenario. The case was challenging in terms of use of anticoagulation and antiplatelet strategy in a rare etiology of acute myocardial infarction following road traffic accident.
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Affiliation(s)
- Rahul R Patil
- Department of Cardiology, Noble Hospital, Hadapsar, Pune, India
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Pawlik MT, Kuenzig HO, Holmer S, Lemberger P, Pfister K, Schreyer AG, Kasprzak P. Concurrent carotid rupture and coronary dissection after blunt chest trauma. ACTA ACUST UNITED AC 2008; 63:E69-72. [PMID: 17483735 DOI: 10.1097/01.ta.0000246185.62754.d5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Michael T Pawlik
- Departments of Anesthesiology, University Hospital Regensburg, Germany.
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Lai CH, Ma T, Chang TC, Chang MH, Chou P, Jong GP. A case of blunt chest trauma induced acute myocardial infarction involving two vessels. Int Heart J 2007; 47:639-43. [PMID: 16960418 DOI: 10.1536/ihj.47.639] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Blunt chest trauma rarely induces acute myocardial infarction. We report a 36-year-old man who suffered from blunt trauma to the anterior chest wall while operating a punching machine. This case is the first report of simultaneous blunt chest trauma to the left anterior descending artery and left circumflex artery. The patient was treated surgically and discharged without any serious sequela. Early detection of the lesion site is important with regard to selecting the appropriate treatment strategy in patients with coronary injury caused by blunt chest trauma. Routine 12-lead electrocardiography and serial cardiac enzyme evaluation are necessary in every patient with chest trauma because they supply crucial information about the extent of cardiac damage. Treatment with primary angioplasty or bypass surgery should be based on the characteristics of the lesion and the associated problem.
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Affiliation(s)
- Chao-Hung Lai
- Division of Cardiology, Armed Forces Taichung General Hospital, Taichung, Taiwan, ROC
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7
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Wilson RF, White CW. Coronary Angiography. CARDIOVASCULAR MEDICINE 2007. [DOI: 10.1007/978-1-84628-715-2_35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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8
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Tsai TN, Yang SP, Tsao TP, Huang KA, Cheng SM. Delayed diagnosis of post-traumatic acute myocardial infarction complicated by congestive heart failure. J Emerg Med 2006; 29:429-31. [PMID: 16243201 DOI: 10.1016/j.jemermed.2005.05.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2004] [Revised: 03/11/2005] [Accepted: 05/20/2005] [Indexed: 10/25/2022]
Abstract
A 53-year-old man experienced persistent chest pain followed by slight shortness of breath after being hit in the chest by a stranger. Chest X-ray study showed no rib fractures but electrocardiography indicated acute anterior wall myocardial infarction. Echocardiography revealed akinesia in both the interventricular septum and anterior left ventricular wall. Emergency cardiac catheterization demonstrated total occlusion of the proximal left anterior descending coronary artery, 9 h after the event. He was successfully treated with coronary angioplasty and stenting procedures. However, poor left ventricular function was observed 3 months after the event despite medications. We conclude that evaluation for possible myocardial injury should be considered soon after blunt chest trauma for early treatment to improve prognosis.
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Affiliation(s)
- Tsung-Neng Tsai
- Division of Cardiology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
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Ismailov RM, Ness RB, Weiss HB, Lawrence BA, Miller TR. Trauma associated with acute myocardial infarction in a multi-state hospitalized population. Int J Cardiol 2006; 105:141-6. [PMID: 16243104 DOI: 10.1016/j.ijcard.2004.11.025] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2004] [Accepted: 11/13/2004] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Trauma has been suggested, in case series, as one of the nonatherosclerotic mechanisms leading to acute myocardial infarction (AMI), the leading cause of death in the US. AMI following non-penetrating injury has been shown to carry significant morbidity and mortality. OBJECTIVE To determine whether hospitalized injuries in a large multi state population are associated with increased risk of AMI during the initial hospital stay. METHODS Statewide injury hospital discharge data were collected from 19 states in 1997. Affected body regions of interest included thoracic, abdominal or pelvic, spine or back and blunt cardiac injury (BCI). The outcome of interest was AMI which was identified based on ICD-9-CM discharge diagnoses for the same visit. Unadjusted and adjusted multivariate logistic regression analyses were performed. RESULTS Independent of confounding factors and coronary arteriography (CA) status, BCI was associated with 2.6-fold increased risk for AMI in persons 46 years or older. When the diagnosis of AMI was confirmed by CA, BCI was associated with 8-fold risk elevation among patients 46 years and older and a 31-fold elevation among patients 45 years and younger. Abdominal or pelvic trauma, irrespective of confounding factors and CA status, was associated with a 65% increase in the risk of AMI among patients 45 years and younger and 93% increase in the risk of among patients 46 years and older. When the diagnosis of AMI was confirmed by CA, abdominal or pelvic trauma was associated with 6-fold risk elevation among patients 46 years and older. CONCLUSION Direct trauma to the heart, as characterized by a diagnosis of BCI, was observed to carry the greatest risk for AMI. Abdominal or pelvic trauma also increased the risk for AMI. Longitudinal studies are warranted to better understand the relationship between trauma and AMI.
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Affiliation(s)
- Rovshan M Ismailov
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, P.O. Box 19122, Pittsburgh, PA 15213, USA.
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Moreno R, Pérez del Todo J, Nieto M, Alba F, Alfonso F, Garcia-Rubira JC, Fernández-Ortiz A, Hernández R, Macaya C. Primary stenting in acute myocardial infarction secondary to right coronary artery dissection following blunt chest trauma. Usefulness of intracoronary ultrasound. Int J Cardiol 2005; 103:209-11. [PMID: 16080983 DOI: 10.1016/j.ijcard.2004.06.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2004] [Accepted: 06/19/2004] [Indexed: 11/16/2022]
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Christensen MD, Nielsen PE, Sleight P. Prior blunt chest trauma may be a cause of single vessel coronary disease; hypothesis and review. Int J Cardiol 2005; 108:1-5. [PMID: 15964088 DOI: 10.1016/j.ijcard.2005.04.010] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2005] [Accepted: 04/01/2005] [Indexed: 11/30/2022]
Abstract
Prompted by a case where a patient (with no risk factors, and single vessel disease) developed angina pectoris after previous blunt chest trauma, we searched Medline for blunt chest trauma and myocardial ischaemia. We found 77 cases describing AMI after blunt chest trauma, but only one reporting angina pectoris. We focused on the age and sex distribution, type of trauma, the angiography findings and the time interval between the trauma and the angiography. The age distribution was atypical, compared to AMI in general; 82% of the patients with AMI after blunt chest trauma were less than 45 years old, and only 2.5% more than 60 years old. The most common trauma was a road traffic accident, and the LAD was the vessel most often affected. Angiography revealed 12 cases with completely normal vessels, which might be due to spasm or recanalisation; 31 cases showed occlusion but no atherosclerosis, which strongly suggested a causal relation between the trauma and subsequent occlusion. AMI should therefore be considered in patients suffering from chest pain after blunt chest trauma. Because traumatic AMI might often be the result of an intimal tear or dissection, thrombolytic therapy might worsen the situation and acute PCI must be considered preferable. It seems likely that lesser damage could lead to longer-term stenosis we suspect that this sequence is grossly under-reported. This could have medico-legal implications.
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Naseer N, Aronow WS, McClung JA, Sanal S, Peterson SJ, Weiss MB, Frishman WH. Circumflex coronary artery occlusion after blunt chest trauma. HEART DISEASE (HAGERSTOWN, MD.) 2003; 5:184-6. [PMID: 12783632 DOI: 10.1097/01.hdx.0000074513.94316.d8] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A 32-year-old white male police officer suffered blunt trauma to the anterior chest wall during a routine training session. This was accompanied by the precipitous onset of chest discomfort. There was no previous history of any cardiac risk factors. The diagnosis of an inferior wall myocardial infarction was made based on the electrocardiogram findings, at his local community hospital. The total creatine kinase, creatine kinase-MB, and troponin I were normal. The transesophageal echocardiogram performed at that time demonstrated no aortic or coronary dissection. He was transferred to our tertiary care center. Emergency cardiac catheterization demonstrated lateral wall hypokinesis with a left ventricular ejection fraction of 45% and a total occlusion of the left circumflex coronary artery in its proximal portion. This was successfully recannulized with angioplasty and stenting techniques. We believe this to be only the second reported case of circumflex coronary artery obstruction after blunt chest trauma.
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Affiliation(s)
- Nauman Naseer
- Department of General Internal Medicine, New York Medical College/Westchester Medical Center, Valhalla, NY, USA.
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13
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O'Neill PA, Sinert RH, Sian KU, Kwan TW. Percutaneous transluminal coronary angioplasty in a patient with myocardial infarction after penetrating trauma. THE JOURNAL OF TRAUMA 2003; 54:1000-5. [PMID: 12777917 DOI: 10.1097/01.ta.0000046700.45106.4b] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Patricia A O'Neill
- Department of Surgery, SUNY-Downstate Medical Center/Kings County Hospital, Brooklyn, New York 11203, USA
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Abstract
Cardiac injuries caused by a heart traumatism are not frequent but, of great importance given their high morbidity. Two different groups in terms of etiology, clinical picture, application of diagnostic techniques, treatment and prognosis can be considered. On one hand, there are cardiac injuries caused by a thoracal contusion, which provokes a contused lesion can affect the free wall, the interventricular septum, the valves, the subvalvular apparatus, the conduction system and the coronary vessels and, on the other hand, cardiac injuries caused by penetrating objects. Cardiac injury can lead to a life-threatening hemodynamic instability which mandates prompt and clear diagnostic and therapeutic approaches.
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Affiliation(s)
- J R Echevarría
- Servicios de Cirugía Cardíaca y Cardiología, ICICOR, Hospital Universitario, Valladolid
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Abstract
Myocardial infarction in persons under the age of 45 years accounts for 6% to 10% of all myocardial infarctions in the United States. In this age group, it is predominantly a disease of men. Important risk factors include a family history of myocardial infarction before age 55 years, hyperlipidemia, smoking, and obesity. Unlike older patients, approximately half of young patients have single-vessel coronary disease, and in up to 20%, the cause is not related to atherosclerosis. Coronary angiography may be warranted in young patients with myocardial infarction to define the anatomy of the disease and to permit optimal management.
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Affiliation(s)
- L Choudhury
- Division of Cardiology, Northwestern Memorial Hospital, Chicago, Illinois, USA
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Abstract
In cardiac trauma the two main mechanisms of injury are blunt and penetrating trauma. Common cardiac effects of trauma include myocardial rupture, contusion, laceration, pericardial insult, coronary injury, valvular damage, arrhythmias, and conduction abnormalities. Hemodynamic instability can develop rapidly and pose marked risk to patient survival. An adequate level of clinical awareness and timely use of diagnostic techniques such as echocardiography, aortography, and cardiac angiography are essential for rapid identification of cardiac trauma. Once the diagnosis is made, prompt surgical intervention is often the key to survival.
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Affiliation(s)
- M R Olsovsky
- Division of Cardiology, Medical College of Virginia, Virginia Commonwealth University, McGuire VA Medical Center, Richmond, USA
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Jessurun GA, den Heijer P, May JF, Lie KI. Coronary angioscopy confirms the presence of red thrombus in acute myocardial infarction after blunt chest trauma. Am Heart J 1996; 131:1216-8. [PMID: 8644603 DOI: 10.1016/s0002-8703(96)90099-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- G A Jessurun
- Department of Cardiology, University Hospital Groningen, The Netherlands
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18
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Salmi A, Blank M, Slomski C. Left anterior descending artery occlusion after blunt chest trauma. THE JOURNAL OF TRAUMA 1996; 40:832-4. [PMID: 8614091 DOI: 10.1097/00005373-199605000-00028] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- A Salmi
- College of Human Medicine, Michigan State University, East Lansing, USA
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Bokelman TA, Rahko PS, Meany BT, Fausch MD. Traumatic occlusion of the right coronary artery resulting in cardiogenic shock successfully treated with primary angioplasty. Am Heart J 1996; 131:411-3. [PMID: 8579046 DOI: 10.1016/s0002-8703(96)90379-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- T A Bokelman
- Department of Medicine, University of Wisconsin Hospitals and Clinics, Madison 53792, USA
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Voyce SJ, Becker RB. Diagnosis, Management, and Complications of Nonpenetrating Cardiac Trauma: A Perspective for Practicing Clinicians. J Intensive Care Med 1993. [DOI: 10.1177/088506669300800602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We provide a state-of-the-art review for practicing clincians concerning diagnosis and treatment of patients with non-penetrating cardiac trauma. Internists, cardiologists, and intensivists are becoming increasingly involved in the diagnosis and management of patients with nonpenetrating cardiac injuries. Electrocardiography and cardiac isoenzyme determinations are the least expensive and most common laboratory tests used to diagnose this condition. Despite widespread use, however, these tests have significant limitations in diagnostic sensitivity and specificy. Two-dimensional echocardiography is advocated by some to improve diagnostic accuracy and to identify patients at increased risk of cardiovascular complications. Patients identified as low risk may be suitable for limited monitoring and early hospital discharge. Transesophageal echocardiography is a useful diagnostic tool that offers many advantages over standard transthoracic imaging. Nuclear medicine techniques, including radionuclide-labeled antimyosin scanning, also represent exciting new developments in this area. Invasive techniques such as cardiac catheterization and pumonary artery catheterization should be reserved for patients with hemodynamic instability and overt mechanical complications. Appropriate selection of diagnostic tests can assist clinicians in rapid traging of patients with nonpenetrating cardiac trauma. Identification of patients at low risk for cardiovascular complications may lead to more appropriate use of hospital resources.
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Affiliation(s)
- Stephen J. Voyce
- Division of Cardiovascular Medicine, University of Massachusetts Medical Center, Worcester, MA
| | - Richard B. Becker
- Division of Cardiovascular Medicine, University of Massachusetts Medical Center, Worcester, MA
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