Abstract
Background: Myocardial ischemia has been associated with motor vehicle collisions
(MVCs). However, we were unable to find reported cases of ST-segment elevation myocardial
infarction (STEMI) leading to ventricular tachyarhythmia and subsequent MVC. In such
patients, decisions regarding antiplatelet and antithrombotic therapy need to balance
the risk of ongoing myocardial ischemia and hemorrhage. Objectives: To describe a
case of STEMI and ventricular fibrillation (VF) associated with a head-on MVC, and
to describe the management decisions involved in the care of such a patient. Case
report: A 47-year-old man presented to the Emergency Department after a single-car
head-on collision with a wall at high speed. He had a facial degloving injury as well
as right-sided flail chest. An electrocardiogram demonstrated ST-segment elevation
in the inferior and anterior leads. Due to the patient's significant traumatic injuries,
he underwent a rapid trauma evaluation and was transferred for emergent cardiac catheterization,
which demonstrated evidence of plaque rupture in the right coronary artery (RCA).
Flow distal to the lesion was preserved, so stent implantation was initially deferred
out of concern for hemorrhage secondary to the aggressive antiplatelet and antithrombotic
regimen requisite with stent implantation. The patient then went into VF in the cardiac
catheterization laboratory, and repeat angiography demonstrated an occluded RCA, and
the patient underwent successful stent implantation. Conclusion: The management of
STEMI in the setting of trauma is complex. Pharmacologic agents used in STEMI increase
the risk of bleeding, and management must balance the risk of prolonged ischemia with
the risk of hemorrhage.
Keywords
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Article info
Publication history
Published online: November 21, 2008
Accepted:
April 19,
2008
Received in revised form:
April 9,
2008
Received:
January 15,
2008
Identification
Copyright
© 2011 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
