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Acute myocardial infarction caused by blast injury of the chest
Insights
Blast injury from explosion shockwaves caused myocardial infarction in a healthy man. This rare case highlights non-physical trauma
Area of Science:
- Cardiology
- Trauma Medicine
Background:
- Myocardial infarction is typically associated with atherosclerosis.
- Blast injuries are known to cause physical trauma, but rarely cardiac events.
Observation:
- A healthy 51-year-old man experienced chest pain after an explosion's shockwaves.
- Initial ECG suggested acute anteroseptal infarction, but he was discharged.
- A follow-up ECG confirmed anteroseptal infarction, with coronary arteriography revealing LAD obstruction.
Findings:
- The patient had no atherosclerosis in other coronary arteries.
- The myocardial infarction is presumed to result from blast-induced intimal tear and/or subintimal hemorrhage in the LAD artery, leading to thrombosis.
Implications:
- Blast wave exposure can cause myocardial infarction without direct physical impact.
- This case expands understanding of non-atherosclerotic causes of myocardial infarction.
- Highlights the need for considering blast injury in cardiac event evaluations.
Abstract:
A 51-year-old healthy man was hit in the chest by the shock-waves generated by an explosion, without being injured by any physical object. He felt immediate chest pain, but, in spite of electrocardiographic tracings highly suspicious for an acute anteroseptal infarction in the emergency room, he was discharged from hospital. The electrocardiogram recorded three weeks later was pathognomonic of anteroseptal infarction. Coronary arteriography performed four months later showed a complete obstruction of the left anterior descending coronary artery, with retrograde filling from the right coronary artery. It is assumed that the myocardial infarction was caused by the blast injury which induced an intimal tear and/or a subintimal haemorrhage in the left anterior descending artery with subsequent thrombosis. The lack of atherosclerosis in any other coronary arteries in this patient is noteworthy.