Multimodal Imaging Unmasks Occult Acute Anterior Myocardial Infarction After Blunt Chest Trauma in a Young Male Patient.

BACKGROUND

Blunt chest trauma is rarely associated with acute plaque rupture and myocardial infarction in young patients without cardiovascular risk factors.

CASE SUMMARY: A 36-year-old man developed severe substernal chest pain immediately after blunt anterior chest trauma while surfing. High-sensitivity troponin I rose rapidly (197-5,700 ng/L over 6 hours). Computed tomography angiography performed to exclude pulmonary embolism showed left ventricular hypoperfusion and a proximal left anterior descending artery filling defect. Echocardiography confirmed an ejection fraction of 40% to 45% with regional wall motion abnormalities. Emergent catheterization revealed 100% thrombotic occlusion of the proximal-to-mid left anterior descending artery due to plaque rupture. Aspiration thrombectomy and drug-eluting stent placement restored TIMI flow grade 3.

DISCUSSION: This case illustrates how multimodal imaging rapidly unmasks occult acute anterior myocardial infarction when initial clinical and electrocardiographic findings are equivocal in the trauma setting.

TAKE-HOME MESSAGES: A low threshold for advanced imaging and serial high-sensitivity troponin monitoring should be maintained in trauma-related chest pain regardless of age or risk factors. Multimodal imaging enables timely reperfusion and excellent outcomes in occult acute myocardial infarction.