traumatic myocardial infarction in a young athletic patient after a sport injury
TRANSCRIPT
FIT Clinical Decision Making
A697JACC April 1, 2014
Volume 63, Issue 12
TraumaTic myocarDial inFarcTion in a young aThleTic paTienT aFTer a sporT injury
Poster ContributionsHall CSunday, March 30, 2014, 3:45 p.m.-4:30 p.m.
Session Title: FIT Clinical Decision Making: Interventional Cardiology and Acute Coronary SyndromeAbstract Category: Acute Coronary SyndromesPresentation Number: 1209-15
Authors: Zaher Fanari, Wasif Qureshi, Christiana Care Health System, Newark, DE, USA
background: Although rare, but blunt chest trauma is one of the non-atherosclerotic mechanisms leading to acute myocardial infarction (MI) in patients younger than 45 years. Myocardial infarction following blunt chest trauma can be secondary to either thrombotic occlusion of the coronary artery after intimal tear, coronary dissection or coronary artery spasm.
case: A 36 years old athletic gentleman with no significant past medical history presented to the emergency department with chest pain that started after another football player felt on him during a game. The chest pain was pressure-like, progressed over 10 minutes and radiated to the left arm and was associated with diaphoresis. Physical examination revealed stable vital signs with no overt signs of chest trauma, his jugular veins were flat, his heart sounds were regular and his lungs sounded clear bilaterally.
Decision-making: Electrocardiogram (ECG) performed on admission demonstrated ST elevation in the inferolateral leads. Patient was treated with Aspirin, Ticagrelor and Bivalirudin.Emergent cardiac catheterization showed right dominant coronary system with acute thrombotic occlusion of the mid right coronary artery. Following aspiration thrombectomy PCI was performed using drug-eluting stent. Post intervention images showed excellent results with no residual stenosis and TIMI 3 flow.
conclusion: The possibility of coronary artery injury should be kept in mind after blunt thoracic trauma. ECG should be obtained early in patients presenting with chest discomfort or dyspnea after blunt chest trauma to evaluate coronary injuries and guide therapy.