Electrocardiographic ST-segment elevation in the trauma patient: acute myocardial infarction vs myocardial contusion
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Fig. 1
Wide complex tachycardia consistent with monomorphic ventricular tachycardia.
Fig. 2
Twelve-lead ECG demonstrating normal sinus rhythm with PAC and ST segment elevation in leads V1 to V4 consistent with either acute myocardial infarction or myocardial contusion.
Fig. 3
Sinus tachycardia with early ST segment elevation and prominent T waves.
Fig. 4
Twelve-lead ECG demonstrating sinus rhythm with significant ST-segment and T-wave changes. Prominent T waves are seen in leads V2 to V4. ST-segment elevation is also seen in this distribution. ST-segment depression is also noted in the inferior leads.
Fig. 5
ST-segment depression in leads V2 to V6 with variable T-wave abnormalities (biphasic to inverted).
Fig. 6
Inverted T waves in leads V1 to V5. In addition, a prominent R wave in leads V1 and V2 is seen likely consistent with incomplete right bundle dysfunction.
Fig. 7
Complete right bundle branch block.
Fig. 8
Second-degree, high-grade atrioventricular block in a hypotensive blunt trauma patient with myocardial injury.
Fig. 9
(A, B) Narrow complex tachycardias consistent with junctional (nodal) tachycardia.
Fig. 10
Ventricular fibrillation.
Abstract
The diagnosis of myocardial contusion in the setting of blunt trauma engenders much discussion and controversy—partly because of the lack of a gold standard for its identification other than histologic findings at autopsy. Furthermore, blunt cardiac trauma represents a spectrum of disorders ranging from transient electrocardiographic change to sudden death from myocardial rupture; hence, no single terminology exists to define such a wide range of scenarios. Here, we present 2 cases of electrocardiographic ST-segment elevation after high-speed motor vehicle crashes resulting in numerous injuries, including blunt chest trauma. Both patients demonstrated electrocardiographic ST-segment elevation, resulting from myocardial contusion and acute myocardial infarction.
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