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[Traumatic infarction following stab wound of the heart (author's transl)]
Insights
A stab wound to the heart caused myocardial infarction due to a severed left coronary artery. This case highlights the severe consequences of chest trauma on coronary blood supply and heart function.
Area of Science:
- Cardiology
- Trauma Surgery
- Forensic Pathology
Background:
- Chest trauma can lead to complex cardiac injuries.
- Myocardial infarction (heart attack) is a critical concern following penetrating cardiac injuries.
Observation:
- A 35-year-old male sustained a stab wound to the left atrium and lung.
- The patient developed a myocardial infarction post-injury and died 40 hours later.
Findings:
- Postmortem examination revealed traumatic left atrial necrosis and a complete severance of the left circumflex coronary artery.
- Anterior-lateral ischemic cardionecrosis of the left ventricle was identified, attributed to the coronary artery severance and right coronary dominance.
Implications:
- This case underscores the critical importance of identifying coronary artery injuries in penetrating cardiac trauma.
- Understanding coronary artery anatomy and dominance is crucial for managing myocardial infarction in trauma patients.
- Distinct morphological differences between traumatic and ischemic myocardial necrosis were observed.
Abstract:
Case report about a myocardial infarction following stab wound of the left atrium including a complete severance of the left coronary artery: An athletic 35-year-old man suffered a latero-medial stab wound of the thorax. The knife had penetrated the left lung and the atrium of the hypertrophic left heart. Postoperatively, the patient developed a heart infarction; 40 h after trauma he died. The postmortem revealed traumatic necrosis of the left atrium, an intraoperatively undiscovered complete severance of the ramus circumflexus arteriae coronariae sinistrae and an antero-lateral ischemic cardionecrosis of the left ventricle. The location of the infarction could be explained by an extreme right preponderance of the coronary blood supply. Traumatic and ischemic myocardial necrosis differed distinctly in the amount of contraction bands. Other causes for such morphological changes like catecholamine-cardiomyopathy (so-called epinephrine myocarditis) or heart operations are discussed.