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Precordial steering wheel: a fortunate accident

Yuri B Pride1, Elizabeth J Frost, Philip D Anderson

  • 1Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215, USA.

The Journal of Emergency Medicine
|November 22, 2008
PubMed
Abstract

Insights

This case report details a patient with ST-segment elevation myocardial infarction (STEMI) and ventricular fibrillation (VF) who caused a motor vehicle collision (MVC). Management involved balancing ischemia and hemorrhage risks during treatment.

Area of Science:

  • Cardiology
  • Emergency Medicine
  • Trauma Surgery

Background:

  • Motor vehicle collisions (MVCs) are sometimes linked to myocardial ischemia.
  • However, ST-segment elevation myocardial infarction (STEMI) causing ventricular tachyarrhythmia and subsequent MVC is rarely reported.
  • Managing antiplatelet and antithrombotic therapy in these patients requires balancing ischemia and hemorrhage risks.

Observation:

  • A 47-year-old male involved in a high-speed, head-on MVC presented with severe facial and chest trauma.
  • Initial ECG showed ST-segment elevation, and cardiac catheterization revealed right coronary artery (RCA) plaque rupture.
  • Stent implantation was deferred due to hemorrhage concerns from antithrombotic therapy.

Findings:

  • The patient developed ventricular fibrillation (VF) in the catheterization lab.
  • Repeat angiography showed an occluded RCA, leading to successful stent implantation.
  • This highlights the complex interplay between trauma, STEMI, and subsequent cardiac events.

Implications:

  • Managing STEMI in trauma patients is challenging due to increased bleeding risks with standard therapies.
  • Treatment decisions must carefully weigh the risk of prolonged myocardial ischemia against the risk of hemorrhage.
  • This case underscores the need for individualized treatment strategies in complex cardiovascular and trauma scenarios.

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