Chest blunt trauma associated to myocardial infarction. Case report

Main Article Content

Macrina Díaz-Méndez
Jorge Arturo Vázquez-Cortés
Juan Ricardo Flores-Arenas
Ruth Del Carmen Rábago-Escoto

Keywords

Myocardial Infarction, Thoracic Traumatisms, Enzymes

Abstract

Background: blunt chest trauma has become a major health problem in the emergency room due to the increase in the number of traffic accidents. The Cardiac contusion is sufficient entity to cause cellular damage and enzymatic electric effects.

Clinical case: 58 years old male, presented chest pain secondary to direct trauma with irradiation to left arm, accompanied by diaphoresis and dyspnea which last 2 hours. Cardiac enzymes serum levels were: CK 2017 CPKMB 381, DHL 823, AST 182; electrocardiogram reported: extensive ischemia with extensive anterior subepicardial injury.

Conclusions: the patient presented without risk factors for coronary disease. The possible mechanism of injury was vasospasm despite the failure to timely perform a coronary angiography which is recommended in these cases. Tests such as the electrocardiogram, measurement of isoenzymes of creatinine phosphokinase-MB levels and echocardiography can be useful and should be performed in all patients with suspected cardiac injury. Treatment modalities include percutaneous coronary intervention and coronary artery bypass surgery.

Abstract 53 | PDF (Spanish) Downloads 7

References

Prêtre R, Chicott M. Blunt trauma to the heart and great vessels. N Engl J Med 1997;336(9): 626-632.

 

Atalar E, Acil T, Aytemir K, Ozer N, Ovunc K, Aksoyek S, et al. Acute anterior myocardial infarction following a mild nonpenetrating chest trauma. A case report. Angiology 2001;52(4):279-282.

 

Fang BR, Li CT. Acute myocardial infarction following blunt chest trauma. Eur Heart J 1994;15 (5):705-707.

 

Díaz JI, Carvajal HM, Babilonia G, Cantillo OE, Pantoja A, Oliver C. Infarto agudo del miocardio debido a trauma cerrado de tórax. Acta Med Colomb 2007;32(2):93-96.

 

Ginzburg E, Dygert J, Parra-Dávila E, Lynn M, Almeida J, Mayor M. Coronary artery stenting for occlusive dissection after blunt chest trauma. J Trauma 1998;45(1):157-161.

 

Moosikasuwan JB, Thomas JM, Buchman TG. Myorcardial infarction as a complication of injury. J Am Coll Surg 2000;190(6):665-670.

 

Christensen MD, Nielsen PE, Sleight P. Prior blunt chest trauma may be a cause of single vessel coronary disease; hypothesis and review. Int J Cardiol 2006;108(1):1-5.

 

Echevarría JR, San Román A. Evaluación y tratamiento de los traumatismos cardiacos. Rev Esp Cardiol 2000;53(5):727-735.

 

Crown LA, Hawkins W. Commotion cordis: clinical implications of blunt cardiac trauma. Am Fam Physician 1997;55(7):2467-2470.

 

Pontillo D, Capezzuto A, Achilli A, Serraino L, Savelli S, Guerra R. Bifascicular block compli-cating blunt cardiac injury. A case report and review of the literature. Angiology 1994;45(10):883- 890.

 

Gozo EG Jr, Cohen HC, Pick A. Traumatic bifas-cicular intraventricular block. Chest 1972;61(3): 294-296. Disponible en http://chestjournal.chestpubs. org/content/61/3/294.long 

 

Ledley G. Yazdanfar S, Friedman O, Kotler MN. Acute thrombotic coronary occlusion secondary to chest trauma treated with intracoronary thrombo-lysis. Am Heart J 1992;123(2):518-521.

 

Parmley LF, Manion WC, Mattingly TW. Non-penetrating traumatic injury of the heart. Circulation 1958;18(3):371-396.

 

Tenzer ML. The spectrum of myocardial contu-sion: a review. J Trauma 1985;25(7):620-627.

 

Chun JH, Lee SC, Gwon HC, Lee SH, Hong KP, Seo JD, et al. Left main coronary artery dissection after blunt chest trauma presented as acute myocardial infarction: assessment by intravascular ultrasound; a case report. J Korean Med Sci 1998;13(3):325-327. Disponible en http://www. jkms.org/Synapse/Data/PDFData/0063JKMS/jkms-13-325.pdf 

 

Marcum Jl, Booth DC, Sapin PM. Acute myo-cardial infarction caused by blunt chest trauma: successful treatment by direct coronary angio-plasty. Am Heart J 1996;132(6):1275-1277.

 

Hilgenberg AD, Austen WG. Traumatismo del corazón y grandes vasos: En: Eagle KA, Haber E, DeSanctis RW, Austen WG, editores. La práctica de la cardiología. Normas del Massachussets General Hospital. Segunda edición. Madrid: Panamericana; 1991.

 

Banzo I, Montero A, Uriarte I, Vallina N, Hernández A, Guede C, et al. Coronary artery occlusion and myocardial infarction: a seldom encountered complication of blunt chest trauma. Clin Nucl Med 1999:24(2):94-96.

 

Rada F, Velandia J, Melgarejo I. Trauma cardiaco y de aorta. En: Mendoza F, Jaramillo C, Merchan A, Melgarejo I, editores. Urgencia cardiovascular: manual de diagnóstico y tratamiento. Cuarta edición. Bogotá: Distribuna; 2006. p. 381-392.

 

Marcum JL, Booth DC, Sapin PM. Acute myo-cardial infarction caused by blunt chest trauma: successful treatment by direct coronary angio-plasty. Am Heart J 1996;132(6):1275-1277.

 

Calvo Ol, Sobrino N, García-Gallego F, Sotillo F, López-Sendón JL, Coma I, et al. Infarto agudo al miocardio postraumático: necesidad de una actitud intervencionista precoz. Rev Esp Cardiol 1992; 45:288-292.

 

Miguel LS, Mike TJ, Sarli IV. Infarto de miocardio causado por lesión arterial coronaria post-traumatismo torácico cerrado. Arq Bras Cardiol 2009;93 (1):e1-e3. Disponible en http://www.scielo.br/pdf/abc/v93n1/es_13.pdf