Acute myocardial infarction following penetrating thoracic trauma: A case report and review of literature. (2019)

• Record Type: Journal Article
• Authors: Bhuller, Sidra B.; Hasan, Sulman R.; Weaver, John; Lieser, Mark
• Is Part Of: International journal of surgery case reports. Volume 65(2019)
• Page Start: 358
• Page End: 360
• Publication Date: 2019
• Subjects: AMI acute myocardial infarction -- PTT penetrating thoracic trauma -- STEMI ST elevation myocardial infarction -- CAD coronary artery disease -- OR operating room -- TTE transthoracic echocardiogram -- LAD left anterior descending -- HTN hypertension -- SBP systolic blood pressure -- MTP Massive transfusion protocol -- pRBCs packed red blood cells -- FFP fresh frozen plasma -- LLL left lower lobe -- ASA aspirin -- BB beta blocker -- ARB angiotensin II receptor blocker -- SBTs spontaneous breathing trials -- HD hospital day -- BTT blunt thoracic trauma; Penetrating thoracic trauma -- Penetrating trauma -- ST elevation myocardial infarction -- Acute myocardial infarction; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2019.11.022
• Languages: English
• ISSNs: 2210-2612

Abstract

Highlights: AMI as a result of penetrating thoracic trauma is rare, but can occur secondary to an acute thrombus, even in the absence of a direct cardiac injury. Regardless of the cause of AMI, medical management should follow current guidelines. Abstract: Introduction: Acute myocardial infarction (AMI) as a result of penetrating thoracic trauma (PTT) is rare; however, there have been a few reports of AMI from gunshot wounds. Presentation of case: A patient without a history of coronary artery disease (CAD) presented with stab wounds to the left chest and underwent a left anterior thoracotomy, left lung wedge resection, negative pericardial window, and negative exploratory laparotomy. Shortly after leaving the operating room (OR) in a stable condition, the patient experienced a STEMI. An acute thrombus in the proximal left anterior descending (LAD) artery was identified. Discussion: AMI as a result of trauma, both blunt and penetrating, is extremely rare. There have been more reports of AMI secondary to blunt trauma, but it is much less common to find reports in literature of AMI from PTT. Conclusion: AMI as a result of penetrating trauma is rare, but can occur secondary to an acute thrombus, even in the absence of a direct cardiac injury. MI should be a consideration in patients with penetrating trauma to the chest, regardless of the intensity of the trauma. At minimum, a 12-lead electrocardiogram (ECG) and a baseline troponin should be obtained at initial evaluation and post-operatively, if surgically managed. If ECG demonstrates findings concerning for MI, it should be followed with an echocardiogram and/or cardiac angiogram to further help guide management, with an early cardiology consultation.