Effective myocardial salvage with percutaneous coronary intervention in late diagnosed acute post-traumatic
Yen-Chen Lin1, Yu-Sheng Chang, Ming-Shyan Chen
1First Cardiovascular Division, Chang Gung Memorial Hospital, Linkou, Taiwan.
Insights
Acute post-traumatic ST-elevation myocardial infarction (STEMI) can be effectively treated with percutaneous coronary intervention (PCI) even when diagnosed late. This case highlights successful myocardial salvage in a delayed STEMI scenario following blunt cardiac injury.
Area of Science:
- Cardiology
- Trauma Surgery
- Emergency Medicine
Background:
- Acute post-traumatic ST-elevation myocardial infarction (STEMI) is a rare but serious complication of blunt cardiac injury.
- Delayed diagnosis of post-traumatic STEMI can hinder effective treatment and myocardial salvage.
Observation:
- A young male sustained blunt thoracic trauma in a motorcycle crash, leading to a delayed diagnosis of STEMI.
- Diagnostic coronary angiography revealed an occluded left anterior descending artery due to dissection and an intimal flap.
Findings:
- Percutaneous coronary intervention (PCI) was performed 18 hours after the onset of STEMI.
- The PCI resulted in immediate and significant improvement in regional left ventricular wall motion and ejection fraction.
Implications:
- This case demonstrates that effective myocardial salvage is achievable with PCI in late-diagnosed acute post-traumatic STEMI.
- Individualized patient management based on clinical scenario is crucial for optimal outcomes in post-traumatic STEMI.
- Early recognition and prompt intervention are vital for improving prognosis in patients with post-traumatic STEMI.
Background:
Acute post-traumatic ST-elevation myocardial infarction (STEMI) is rare but potentially disastrous in patients with blunt cardiac injury. Sometimes the diagnosis is delayed. Failed myocardial salvage by percutaneous coronary intervention (PCI) within 9 h after the onset of post-traumatic STEMI has been described.
Objective:
We present a case report of a patient in whom effective myocardial salvage with PCI was obtained in a late diagnosed acute post-traumatic STEMI.
Case Report:
We report the case of a young man who was involved in a motorcycle crash, who had a delayed diagnosis of post-traumatic STEMI. Diagnostic coronary angiography was performed to guide treatment strategy. An occluded left anterior descending artery due to a dissection, and an intimal flap at the first diagonal branch were found. A PCI was done 18 h after the onset of the event with striking and immediate improvement of the regional left ventricular wall motion and ejection fraction.
Conclusion:
After blunt thoracic injury, there is the possibility of an acute post-traumatic STEMI being present when facing a patient with clues of blunt cardiac injury. If the diagnosis of acute post-traumatic STEMI is clinically strong, the patient should be managed individually according to the clinical scenario. Early recognition and prompt management are vital when dealing with patients suffering post-traumatic STEMI.
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