Deutsche medizinische Wochenschrift (1946) · 2012
[Subacute anterior myocardial infarction after mild blunt chest trauma in a 32-year-old man].
Клинический случайАннотация на английскомСтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Halboos A, Jacksch R
Аннотация
HISTORY AND CLINICAL FINDING: A 32-year-old man came to the surgical department because of persisting retrosternal pain radiating to the left side of the thorax for two days. During a move an armchair had slipped out of his hands and caused a mild blunt chest trauma. The further clinical examination findings were unremarkable.
INVESTIGATIONS: Echocardiography was performed to rule out myocardial contusion. It showed a slightly reduced left-ventricular ejection fraction (EF 52 %) with akinesia of all apical segments overlapping to the septal and anterolateral wall, reaching the mid-ventricular area. The electrocardiogram (ECG) revealed a complete loss of R voltage of the anterior wall with persisting ST elevations in V4-V6. Coronary angiography showed a short-length thrombotic occlusion of the left anterior descending artery (LAD) immediately after giving off the diagonal branch, based on a plaque-rupture.
TREATMENT AND COURSE: Because of the subacute myocardial infarction in combination with a bifurcation problem a drug-eluting stent was inserted in accordance with current studies. Initial cardiac MRT showed slightly reduced left-ventricular ejection fraction (EF 50 %), while myocardial wall thickness was preserved in all segments. Four weeks later severe myocardial remodeling had caused transmural scar formation of the anterior wall which had resulted in a reduction of left-ventricular EF to 39 %.
CONCLUSION: Myocardial infarction based on plaque-rupture can occur after a mild blunt chest trauma even in young patients. An early cardiological examination, at least an ECG, should be performed to avoid complications of mild, painful blunt chest trauma.
INVESTIGATIONS: Echocardiography was performed to rule out myocardial contusion. It showed a slightly reduced left-ventricular ejection fraction (EF 52 %) with akinesia of all apical segments overlapping to the septal and anterolateral wall, reaching the mid-ventricular area. The electrocardiogram (ECG) revealed a complete loss of R voltage of the anterior wall with persisting ST elevations in V4-V6. Coronary angiography showed a short-length thrombotic occlusion of the left anterior descending artery (LAD) immediately after giving off the diagonal branch, based on a plaque-rupture.
TREATMENT AND COURSE: Because of the subacute myocardial infarction in combination with a bifurcation problem a drug-eluting stent was inserted in accordance with current studies. Initial cardiac MRT showed slightly reduced left-ventricular ejection fraction (EF 50 %), while myocardial wall thickness was preserved in all segments. Four weeks later severe myocardial remodeling had caused transmural scar formation of the anterior wall which had resulted in a reduction of left-ventricular EF to 39 %.
CONCLUSION: Myocardial infarction based on plaque-rupture can occur after a mild blunt chest trauma even in young patients. An early cardiological examination, at least an ECG, should be performed to avoid complications of mild, painful blunt chest trauma.