Coronary angioscopy confirms the presence of red thrombus in acute myocardial infarction after blunt chest trauma

Delayed diagnosis of post-traumatic acute myocardial infarction complicated by congestive heart failure

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.

Prior blunt chest trauma may be a cause of single vessel coronary disease; hypothesis and review

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.

Circumflex coronary artery occlusion after blunt chest trauma

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.

Delayed death owing to blunt cardiac injury

Two cases of blunt myocardial injury to the region of the anterior descending branch of the left coronary artery causing death are described. In one case, direct injury appeared to have resulted in myocardial infarction, whereas in the other, cardiac arrhythmia (possibly secondary to coronary artery spasm) was implicated. Although apparently uncommon, deaths following blunt injury to the coronary arteries may cause death, but are difficult to predict and prevent.

Unusual cause of sudden cardiac death: basophilic degeneration of coronary arteries

Basophilic or mucoid degeneration of the intima in the coronary arteries is an extremely rare cause of premature atherosclerosis. An unusual case of fatal basophilic degeneration of the coronary arteries 142 days after delivery is reported.