Multimodal Imaging Unmasks Occult Acute Anterior Myocardial Infarction After Blunt Chest Trauma in a Young Male...

Blunt chest trauma is rarely associated with acute plaque rupture and myocardial infarction in young patients without cardiovascular risk factors.

A 36-year-old man developed severe substernal chest pain immediately after blunt anterior chest trauma while surfing. High-sensitivity troponin I rose rapidly (197-5,700 ng/L over 6 hours). Computed tomography angiography performed to exclude pulmonary embolism showed left ventricular hypoperfusion and a proximal left anterior descending artery filling defect. Echocardiography confirmed an ejection fraction of 40% to 45% with regional wall motion abnormalities. Emergent catheterization revealed 100% thrombotic occlusion of the proximal-to-mid left anterior descending artery due to plaque rupture. Aspiration thrombectomy and drug-eluting stent placement restored TIMI flow grade 3.

This case illustrates how multimodal imaging rapidly unmasks occult acute anterior myocardial infarction when initial clinical and electrocardiographic findings are equivocal in the trauma setting.

A low threshold for advanced imaging and serial high-sensitivity troponin monitoring should be maintained in trauma-related chest pain regardless of age or risk factors. Multimodal imaging enables timely reperfusion and excellent outcomes in occult acute myocardial infarction.