ST-Elevation Myocardial Infarction after Penetrating Thoracic Trauma

Publication date: Available online 17 March 2017
Source:The Journal of Emergency Medicine
Author(s): Kiran Faryar, Michael P. Flaherty, Martin Huecker
BackgroundST-segment elevation myocardial infarction (STEMI) may complicate penetrating thoracic trauma.Case ReportThis report describes a 42-year-old man who sustained a self-inflicted gunshot wound to the left chest. Electrocardiogram showed ST elevation in the inferior leads. Emergent catheterization was not recommended and conservative management was initiated. Cardiac catheterization 4 days later showed no perturbation of the coronary arteries, neither atherosclerotic nor traumatic.Why Should an Emergency Physician Be Aware of This?This case is unusual because it demonstrates a STEMI with no detectable plaque rupture or gunshot pellets on coronary catheterization. The decision to aggressively manage these patients with early coronary angiography depends on the hemodynamic status of the patient, their cardiac risk factors, and their ability to tolerate ischemic insult. In asymptomatic hemodynamically stable patients, conservative medical management should be considered. Myocardial infarction is a complication after penetrating thoracic trauma and should be considered in initial evaluation.



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