Sun Guangfeng, Huang Shan, Kang Huiyuan, Wang Bin
Department of Emergency, Xiamen Cardiovascular Hospital, Xiamen University, No. 2999 Jinshan Road, Huli District, Xiamen, China 361000.
Department of Intensive Care Unit, Xiamen Cardiovascular Hospital, Xiamen University, No. 2999 Jinshan Road, Huli District, Xiamen, China 361000.
Eur Heart J Case Rep. 2025 Aug 16;9(9):ytaf402. doi: 10.1093/ehjcr/ytaf402. eCollection 2025 Sep.
Trauma-related acute myocardial infarction represents a complex and high-risk condition in the emergency department, necessitating a range of sophisticated treatment strategies. Failure to provide timely and accurate intervention significantly increases the risk of short-term mortality.
We present the case of a 36-year-old male who was admitted to local hospital following a penetrating chest trauma. Relevant diagnostic evaluations revealed haemopneumothorax and shock. Following initial stabilization measures, the patient was urgently transferred to our institution due to haemopericardium, which was initially suspected to be secondary to traumatic aortic dissection. However, the admission electrocardiogram clearly demonstrated concurrent anterior and high lateral wall myocardial infarction. Coronary angiography revealed occlusion of the left anterior descending (LAD) artery. We attempted interventional therapy on the LAD to restore blood flow. However, intraoperative findings revealed complete rupture of the LAD. The patient was transferred to the cardiac surgery department for emergency coronary artery bypass grafting (CABG). The foreign body was successfully retrieved, and the CABG was completed without complications. The patient gradually recovered under short-term ECMO support and was discharged successfully. Follow-up assessments indicate a favourable recovery.
The mechanism underlying traumatic myocardial infarction is complex and variable. Given that emergency physicians and cardiologists often lack extensive experience in such cases, they should exercise caution, conduct a thorough assessment, and meticulously plan each step of diagnosis and treatment.
创伤相关的急性心肌梗死是急诊科一种复杂且高危的病症，需要一系列复杂的治疗策略。未能及时、准确地进行干预会显著增加短期死亡风险。
我们报告一例36岁男性患者，因胸部穿透伤入住当地医院。相关诊断评估显示血气胸和休克。经过初步的稳定措施后，患者因心包积血被紧急转至我院，最初怀疑是创伤性主动脉夹层所致。然而，入院心电图明确显示同时存在前壁和高侧壁心肌梗死。冠状动脉造影显示左前降支（LAD）动脉闭塞。我们尝试对LAD进行介入治疗以恢复血流。然而，术中发现LAD完全破裂。患者被转至心脏外科进行紧急冠状动脉旁路移植术（CABG）。异物成功取出，CABG顺利完成，无并发症发生。患者在短期体外膜肺氧合（ECMO）支持下逐渐康复并成功出院。随访评估显示恢复良好。
创伤性心肌梗死的潜在机制复杂且多变。鉴于急诊医生和心脏病专家在这类病例中往往缺乏丰富经验，他们应谨慎行事，进行全面评估，并精心规划诊断和治疗的每一步。
