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[Acute traumatic myocardial infarction with cardiogenic shock in severe polytrauma--a case report]
1Klinik und Poliklinik für Anästhesiologie und Intensivmedizin, Ernst-Moritz-Arndt-Universität Greifswald.
Insights
Severe polytrauma led to myocardial infarction and cardiogenic shock. Intra-aortic balloon pump effectively supported circulation during complex management of this traumatic myocardial infarction.
Area of Science:
- Cardiology
- Trauma Surgery
- Intensive Care Medicine
Background:
- Traumatic myocardial infarction (TMI) is a rare but severe complication of polytrauma.
- Management is challenging due to contraindications for standard reperfusion therapies and coexisting injuries.
Observation:
- A 41-year-old male with severe polytrauma developed TMI and cardiogenic shock.
- Percutaneous transluminal coronary angioplasty (PTCA) for left interventricular artery dissection failed.
- Intraabdominal hemorrhage necessitated emergency laparotomy, complicating cardiac insufficiency management.
Findings:
- Intra-aortic balloon counterpulsation (IABP) provided crucial circulatory support.
- Successful management required a coordinated approach to both cardiac ischemia and polytrauma injuries.
Implications:
- This case highlights the feasibility and importance of integrated treatment strategies for TMI.
- IABP can be a vital tool in managing hemodynamically unstable patients with TMI and polytrauma.
- Emphasizes the need for multidisciplinary collaboration in complex trauma cases.
Abstract:
A 41-year-old man suffered severe polytrauma and developed a traumatic myocardial infarction with cardiogenic shock. Thrombolysis as well as coronary bypass grafting was contraindicated due to accompanying injuries. An attempted early coronary revascularization by percutaneous transluminal coronary angioplasty (PTCA) failed due to dissection of the left interventricular coronary artery. Treatment of cardiac insufficiency was complicated by intraabdominal haemorrhage enforcing emergency laparotomy. Intraaortic balloon counterpulsation proved to be efficient in supporting circulation in these circumstances. The case report documents the practicability and importance of treating both myocardial ischaemia and attending injuries in an equivalent and coordinated manner in traumatic myocardial infarction.