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Bilateral forearm and hand compartment syndrome following thrombolysis for acute myocardial infarction: a case report
W O Thomas1, C N Harris, T F D'Amore
1University of South Alabama School of Medicine, Mobile.
Insights
A patient experienced compartment syndrome after cocaine-induced heart attack treatment. Prompt surgical decompression preserved hand function, highlighting critical management strategies for this rare complication.
Area of Science:
- Cardiology
- Vascular Surgery
- Trauma Management
Background:
- Cocaine use is a known risk factor for myocardial infarction.
- Thrombolytic therapy is a standard treatment for acute myocardial infarction.
- Radial artery cannulation is a common procedure for hemodynamic monitoring.
Observation:
- A patient developed acute bilateral compartment syndromes of the upper extremities and hands following thrombolytic therapy for cocaine-induced myocardial infarction.
- The compartment syndromes were attributed to bleeding complications from attempted bilateral radial artery cannulation.
- This complication led to significant forearm and hand swelling and compromised circulation.
Findings:
- Emergent decompression of the forearm compartments and intrinsic hand muscles was performed.
- The patient experienced an excellent recovery of hand function.
- No significant neurologic or muscular damage was observed post-operatively.
Implications:
- This case highlights a rare but serious complication of radial artery cannulation in patients treated with thrombolysis.
- Early recognition and emergent surgical intervention are crucial for preserving limb function.
- Recommendations for prevention and management strategies are discussed to minimize risks in similar clinical scenarios.
Abstract:
A patient suffering from a cocaine-induced myocardial infarction was treated with thrombolytic therapy and developed acute bilateral compartment syndromes of the upper extremities and hands from bleeding due to attempted bilateral radial artery cannulation. He was treated with emergent decompression of the forearm compartments and intrinsic muscles of the hands and recovered excellent hand function without significant neurologic or muscular damage. The problems encountered in the management of this case are detailed, and recommendations for prevention and therapy are discussed.