Race-over time: a critical case of acute myocardial infarction and ventricular tachycardia following blunt chest trauma

Race-over time: a critical case of acute myocardial infarction and ventricular tachycardia following blunt chest trauma | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Race-over time: a critical case of acute myocardial infarction and ventricular tachycardia following blunt chest trauma Kun Lin, Chao Qin, Tao He This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5617157/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 30 May, 2025 Read the published version in Journal of Cardiothoracic Surgery → Version 1 posted 8 You are reading this latest preprint version Abstract Introduction Blunt chest trauma resulting in cardiac injury is a significant cause of mortality in trauma patients. Among the most critical sequelae, acute myocardial infarction (AMI) and ventricular tachycardia (VT) require prompt medical attention because of their potentially life-threatening nature. This case report examines the clinical progression and therapeutic approach in a patient who presented with these severe cardiac complications. Case presentation A 42-year-old male was admitted with significant sternal pain, acute respiratory compromise, and substantial hemorrhage from cranial and facial injuries following a traumatic event. Initial clinical evaluation revealed elevated cardiac biomarkers and electrocardiographic abnormalities, resulting in the diagnosis of acute myocardial infarction (AMI) complicated by ventricular tachycardia (VT). Conclusion This investigation underscores the paramount importance of expeditious diagnosis and intervention for acute myocardial infarction (AMI) and ventricular tachycardia (VT) in patients with blunt chest trauma. These findings demonstrate that even with comprehensive therapeutic intervention, severe cardiac complications may result in adverse outcomes. Blunt chest trauma ventricular tachycardia myocardial infarction Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Introduction Blunt chest trauma presents significant clinical challenges, manifesting as various severe injuries, including pulmonary contusions, hemothorax, and rib fractures. The cardiac implications of such trauma include potential compromise of the myocardium, pericardium, major thoracic vessels, and coronary arteries. Of particular concern is coronary artery dissection, an infrequent yet potentially life-threatening complication that may precipitate acute myocardial infarction. The timely identification and appropriate management of these injuries are fundamental determinants of patient outcomes. This report examines a case in which multiple blunt chest injuries culminated in a fatal acute myocardial infarction. Case report (The red font indicates the modified content). A 42-year-old male patient was brought to the emergency department following a traumatic incident involving a fall from an electric bicycle. He presented with severe sternal pain, respiratory distress, and significant cephalofacial hemorrhage. The patient was initially unresponsive and had blood actively pouring from the oral cavity. Emergency medical services arrived at the scene within five minutes. Initial management included airway clearance, administration of oxygen via a face mask, and intravenous fluid resuscitation. During transport to the hospital, the patient vomited twice, expelling dark red liquid mixed with gastric contents. He subsequently regained consciousness.Following initial stabilization measures, the patient was transferred to a proximate medical facility for comprehensive diagnostic evaluation. Laboratory studies revealed elevated cardiac biomarkers suggestive of myocardial injury, whereas computed tomography revealed multiple traumatic injuries, including pulmonary contusions and skeletal fractures. Initial electrocardiographic assessment demonstrated evidence of acute myocardial ischemia. Owing to the critical nature of his condition, immediate transfer to our emergency department was initiated. Vital signs were as follows: blood pressure BP 86/56 mmHg, pulse 140 beats/min, respiratory rate 25 breaths/min, and oxygen saturation SpO₂ 80%. The patient was hemodynamically unstable, with active bleeding and respiratory distress noted. Comprehensive diagnostic evaluation, including advanced imaging studies, ultrasonography, electrocardiography, and serological analysis was performed. Abnormal Findings in investigations: electrocardiographic assessment revealed ventricular tachycardia (VT) (Fig. 1 ). CT Scan: Pulmonary contusion, left clavicle fracture, multiple facial fractures (including left zygomatic arch, nasal bone, and orbital walls), and extensive paranasal sinus hematoma/effusion. Soft tissue swelling and subcutaneous emphysema were noted in the left jaw and eyelid, with swelling of the left medial rectus muscle. No abnormalities were detected in the head CT. Echocardiography: Left atrial and ventricular enlargement, hypokinesis of the anterior wall and septum, mild mitral regurgitation, and borderline left ventricular systolic function (EF at lower normal limit). No pericardial effusion was observed.Laboratory Tests: Leukocytosis (WBC 23.21 × 10⁹/L), hypokalemia (K⁺ 2.98 mmol/L), elevated liver enzymes (AST 333 U/L, ALT 181 U/L), and elevated cardiac biomarkers (troponin T 111 ng/L, CK-MB 12.9 ng/mL, myoglobin 385.5 ng/mL, D-dimer 5 mg/L).Therapeutic interventions included analgesic administration, cardiac rate management, volume resuscitation, electrolyte optimization, and tetanus prophylaxis. Following a six-hour interval, the patient manifested clinical deterioration characterized by acute agitation, thoracic discomfort, progressive respiratory compromise, and diaphoresis. Subsequent electrocardiographic evaluation revealed extensive anterior wall and lateral wall myocardial infarction (Fig. 2 ). This finding, in conjunction with elevated high-sensitivity troponin values (Fig. 3 ), confirmed the diagnosis of acute extensive anterior and lateral wall myocardial infarction. The patient was admitted to the intensive care unit (ICU) for the initiation of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) to provide cardiopulmonary support. Subsequently, transfer to the cardiac catheterization laboratory was executed for urgent coronary angiography and intra-aortic balloon pump placement to evaluate coronary architecture and enhance hemodynamic stability. Left main coronary artery catheterization revealed significant obstruction with distal stenosis (Fig. 4), accompanied by 20–30% diffuse stenosis of the right coronary artery. Coronary imaging demonstrated compression and obstruction secondary to hematoma formation. Three coronary stents were implanted ,the postoperative angiography demonstrated that the stent has expanded well(Fig. 5 ). Despite therapeutic intervention involving coronary stent deployment and intra-aortic balloon pump (IABP) support to optimize coronary perfusion, the patient experienced multiple adverse events, including coronary arterial rupture, myocardial infarction, and cardiogenic shock. These complications culminated in progressive circulatory compromise, multiple organ dysfunction syndrome. The patient unfortunately passed away 3 days later. Discussion This case details the presentation of a 42-year-old male patient who developed acute myocardial infarction (AMI) and ventricular tachycardia (VT) subsequent to multiple blunt traumas, with significant chest involvement. The patient's clinical course, despite comprehensive therapeutic intervention, underscores the fundamental importance of prompt diagnosis and integrated management in trauma patients with suspected cardiac involvement. The occurrence of AMI following blunt chest trauma represents an infrequent complication. Epidemiological data from postmortem analyses indicate cardiac injury in 20% of blunt chest trauma cases, with coronary vessel involvement documented in less than 2% of cases [ 1 ]. Coronary dissection is most common in the left anterior descending( LAD) artery (76%), followed by the right coronary (12%) and circumflex (6%)[ 2 ]. The LADʼs susceptibility is due to its anterior position, proximity to the sternum, and longer course, making it prone to shear stress from blunt trauma.Notably, while left main coronary artery dissection is exceptionally rare (< 1% of traumatic coronary injuries), its occurrence has been pathologically confirmed through intravascular ultrasound, demonstrating how high-energy trauma can induce longitudinal intimal tears even in proximal coronary segments [ 3 ].The underlying mechanisms of trauma-induced AMI include various pathological processes, including coronary vessel disruption, thrombotic events, atherosclerotic plaque destabilization, aneurysm formation, and arterial dissection [ 4 ]. The observed complete occlusion of the left main coronary artery in this case represents a particularly rare manifestation. The diagnostic process for AMI in the context of blunt chest trauma poses substantial clinical challenges. Primary cardiac manifestations may be obscured by concurrent injuries such as costal fractures or pulmonary contusions, potentially resulting in delayed recognition of cardiac sequelae—a critical determinant of clinical outcomes. In the present case, initial electrocardiographic evaluation revealed ventricular tachycardia, a significant arrhythmia associated with, but not pathognomonic for, AMI. Classical myocardial infarction indicators emerged in the subsequent hours. The patient's AMI presentation was attributed to traumatic coronary artery dissection, necessitating immediate therapeutic intervention and intensive monitoring. The implementation of percutaneous coronary intervention (PCI) in such cases presents significant therapeutic considerations [ 5 ]. While this intervention provides essential hemodynamic support, it carries inherent risks, particularly regarding hemorrhagic complications. The patient may experienced substantial bleeding following heparin administration during PCI, highlighting the necessity for meticulous evaluation of anticoagulation risks and benefits in trauma patients. Coronary angiography and subsequent intervention remain essential components in the management of trauma-induced AMI, serving both diagnostic and therapeutic objectives. Angiographic evaluation in this case demonstrated complete left main coronary occlusion, which was addressed through angioplasty. However, identification and management of the primary lesion are insufficient to prevent mortality. This clinical presentation emphasizes the necessity for enhanced vigilance in patients with blunt chest trauma. Cardiac injury may be masked by more apparent traumatic manifestations, such as pulmonary contusions or skeletal fractures. Consequently, maintaining a high index of suspicion for cardiac complications and initiating prompt cardiac enzyme analysis and electrocardiographic evaluation are essential for optimal therapeutic timing [ 6 ]. Conclusion The management of posttraumatic AMI and VT necessitates a sophisticated, multidisciplinary therapeutic strategy. While significant advancements have been made in interventional cardiology and critical care medicine, clinical outcomes continue to demonstrate considerable variability. Additional clinical research initiatives are essential to enhance therapeutic protocols and optimize patient outcomes in these medically complex scenarios. Abbreviations AMI Acute myocardial infarction VT Ventricular tachycardia ECG Electrocardiogram VA-ECMO Veno-arterial extracorporeal membrane oxygenation IABP Intra-aortic balloon pump PCI Percutaneous coronary intervention LAD left anterior descending Declarations This case report was conducted in accordance with the standards of the Declaration of Helsinki. Consent for publication This case report is a retrospective study, and the patient unfortunately passed away and was unable to sign the informed consent form. The ethical review of this article was approved by the Ethics Committee of the First Affiliated Hospital of Guangxi Medical University. Clinical trial number not applicable. Competing interests The authors declare that they have no competing interests. Funding Not applicable. Author Contribution K.L. and C.Q. wrote the main manuscript text and prepared Figs. 1, 2, 3, and 4. All the authors reviewed the manuscript Acknowledgements Not applicable. Data availability All the data and materials described in the manuscript are not publicly available because the containing information could compromise the privacy of the patient. K.L. should be contacted if someone wants to request the data on a reasonable request. References Prêtre R, Chilcott M. Blunt trauma to the heart and great vessels. N Engl J Med. 1997;336:626–32. Shao Y, Xia W, Zhang C, Wang X. Bilateral coronary dissection after blunt thoracic trauma: a case report. Can J Cardiol. 2012;28(515):e1–2. Chun JH, Lee SC, Gwon HC, et al. Left Main coronary artery dissection after blunt chest trauma presented as acute myocardial infarction: assessment by intravascular ultrasound: a case report. J Korean Med Sci. 1998;13:325–7. Janella BL, Pinto RJ, Pena HP, Carneiro JG, Sousa MR, Andrade MA Jr. Acute myocardial infarction related to blunt thoracic trauma. Arq Bras Cardiol. 2006;87(6):e239–42. Lin YC, Chang YS, Chen MS, Ho WJ, Kuo CT, Chang CJ. Effective myocardial salvage with percutaneous coronary intervention in late diagnosed acute post-traumatic ST-elevation myocardial infarction. J Emerg Med. 2012;42(1):28–35. Orliaguet G, Ferjani M, Riou B. heart blunt trauma Anesthesiology. 2001;95(2):544–48. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 30 May, 2025 Read the published version in Journal of Cardiothoracic Surgery → Version 1 posted Editorial decision: Accepted 11 May, 2025 Reviews received at journal 28 Apr, 2025 Reviewers agreed at journal 24 Apr, 2025 Reviews received at journal 23 Apr, 2025 Reviewers agreed at journal 23 Apr, 2025 Reviewers invited by journal 22 Apr, 2025 Submission checks completed at journal 16 Apr, 2025 First submitted to journal 15 Apr, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5617157","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":446528211,"identity":"a3a06ff2-dd21-4865-be8a-33a7da9af317","order_by":0,"name":"Kun Lin","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Kun","middleName":"","lastName":"Lin","suffix":""},{"id":446528212,"identity":"468f071f-fe83-49b6-846d-b4bf33e90c6e","order_by":1,"name":"Chao 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13:38:32","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5617157/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5617157/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s13019-025-03470-2","type":"published","date":"2025-05-30T15:57:00+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":81582391,"identity":"b63b1cd8-f0b0-41b5-96a5-e5a829423bca","added_by":"auto","created_at":"2025-04-28 19:36:26","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":624879,"visible":true,"origin":"","legend":"\u003cp\u003eInitial electrocardiogram demonstrating ventricular tachycardia.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-5617157/v1/9b39888ab41b8d26a2f4c73f.png"},{"id":81582901,"identity":"fcb0d8f3-3dae-4314-a8f4-ccc10360fe32","added_by":"auto","created_at":"2025-04-28 19:44:26","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":182430,"visible":true,"origin":"","legend":"\u003cp\u003eFollow-up electrocardiogram obtained during acute chest pain presentation, demonstrating extensive anterior wall and lateral wall myocardial infarction.\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-5617157/v1/9fa7ae2d72c1e0f5cd3a0dcb.png"},{"id":81582390,"identity":"7d0d2672-2522-4dcf-a030-8e55b5a0a3ee","added_by":"auto","created_at":"2025-04-28 19:36:26","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":18137,"visible":true,"origin":"","legend":"\u003cp\u003eSerial high-sensitivity troponin measurements obtained postadmission (ng/L).\u003c/p\u003e","description":"","filename":"floatimage3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-5617157/v1/8e354b9ab5e69bec95b983c0.jpeg"},{"id":81582900,"identity":"5e13fb3c-4c20-483f-8350-5bed3ff7e9a7","added_by":"auto","created_at":"2025-04-28 19:44:26","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":695462,"visible":true,"origin":"","legend":"\u003cp\u003eCoronary angiographic findings demonstrating complete occlusion of the left main coronary artery with associated distal compression.\u003c/p\u003e","description":"","filename":"floatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-5617157/v1/ffc80291598a308a0fd5ae6d.png"},{"id":81582393,"identity":"f180b3cc-720f-45e1-8f9d-9b1d24d70c12","added_by":"auto","created_at":"2025-04-28 19:36:26","extension":"jpeg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":246328,"visible":true,"origin":"","legend":"\u003cp\u003eThe postoperative angiography demonstrated that the stent has expanded well, with TIMI 2 flow in the left main artery and left anterior descending.\u003c/p\u003e","description":"","filename":"floatimage58.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-5617157/v1/2ffdb7328ec676710d55dc75.jpeg"},{"id":83784045,"identity":"953cc6ab-b869-43d4-a7e8-76546c382498","added_by":"auto","created_at":"2025-06-02 16:19:03","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2050326,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5617157/v1/475f8a51-3b9e-4408-a07f-f3e3c8b554ae.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Race-over time: a critical case of acute myocardial infarction and ventricular tachycardia following blunt chest trauma","fulltext":[{"header":"Introduction","content":"\u003cp\u003eBlunt chest trauma presents significant clinical challenges, manifesting as various severe injuries, including pulmonary contusions, hemothorax, and rib fractures. The cardiac implications of such trauma include potential compromise of the myocardium, pericardium, major thoracic vessels, and coronary arteries. Of particular concern is coronary artery dissection, an infrequent yet potentially life-threatening complication that may precipitate acute myocardial infarction. The timely identification and appropriate management of these injuries are fundamental determinants of patient outcomes. This report examines a case in which multiple blunt chest injuries culminated in a fatal acute myocardial infarction.\u003c/p\u003e"},{"header":"Case report","content":"\u003cp\u003e(The red font indicates the modified content).\u003c/p\u003e \u003cp\u003eA 42-year-old male patient was brought to the emergency department following a traumatic incident involving a fall from an electric bicycle. He presented with severe sternal pain, respiratory distress, and significant cephalofacial hemorrhage. The patient was initially unresponsive and had blood actively pouring from the oral cavity. Emergency medical services arrived at the scene within five minutes. Initial management included airway clearance, administration of oxygen via a face mask, and intravenous fluid resuscitation. During transport to the hospital, the patient vomited twice, expelling dark red liquid mixed with gastric contents. He subsequently regained consciousness.Following initial stabilization measures, the patient was transferred to a proximate medical facility for comprehensive diagnostic evaluation. Laboratory studies revealed elevated cardiac biomarkers suggestive of myocardial injury, whereas computed tomography revealed multiple traumatic injuries, including pulmonary contusions and skeletal fractures. Initial electrocardiographic assessment demonstrated evidence of acute myocardial ischemia.\u003c/p\u003e \u003cp\u003eOwing to the critical nature of his condition, immediate transfer to our emergency department was initiated. Vital signs were as follows: blood pressure BP 86/56 mmHg, pulse 140 beats/min, respiratory rate 25 breaths/min, and oxygen saturation SpO₂ 80%. The patient was hemodynamically unstable, with active bleeding and respiratory distress noted. Comprehensive diagnostic evaluation, including advanced imaging studies, ultrasonography, electrocardiography, and serological analysis was performed. Abnormal Findings in investigations: electrocardiographic assessment revealed ventricular tachycardia (VT) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). CT Scan: Pulmonary contusion, left clavicle fracture, multiple facial fractures (including left zygomatic arch, nasal bone, and orbital walls), and extensive paranasal sinus hematoma/effusion. Soft tissue swelling and subcutaneous emphysema were noted in the left jaw and eyelid, with swelling of the left medial rectus muscle. No abnormalities were detected in the head CT. Echocardiography: Left atrial and ventricular enlargement, hypokinesis of the anterior wall and septum, mild mitral regurgitation, and borderline left ventricular systolic function (EF at lower normal limit). No pericardial effusion was observed.Laboratory Tests: Leukocytosis (WBC 23.21 \u0026times; 10⁹/L), hypokalemia (K⁺ 2.98 mmol/L), elevated liver enzymes (AST 333 U/L, ALT 181 U/L), and elevated cardiac biomarkers (troponin T 111 ng/L, CK-MB 12.9 ng/mL, myoglobin 385.5 ng/mL, D-dimer 5 mg/L).Therapeutic interventions included analgesic administration, cardiac rate management, volume resuscitation, electrolyte optimization, and tetanus prophylaxis.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFollowing a six-hour interval, the patient manifested clinical deterioration characterized by acute agitation, thoracic discomfort, progressive respiratory compromise, and diaphoresis. Subsequent electrocardiographic evaluation revealed extensive anterior wall and lateral wall myocardial infarction (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). This finding, in conjunction with elevated high-sensitivity troponin values (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e), confirmed the diagnosis of acute extensive anterior and lateral wall myocardial infarction. The patient was admitted to the intensive care unit (ICU) for the initiation of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) to provide cardiopulmonary support. Subsequently, transfer to the cardiac catheterization laboratory was executed for urgent coronary angiography and intra-aortic balloon pump placement to evaluate coronary architecture and enhance hemodynamic stability. Left main coronary artery catheterization revealed significant obstruction with distal stenosis (Fig.\u0026nbsp;4), accompanied by 20\u0026ndash;30% diffuse stenosis of the right coronary artery. Coronary imaging demonstrated compression and obstruction secondary to hematoma formation. Three coronary stents were implanted ,the postoperative angiography demonstrated that the stent has expanded well(Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDespite therapeutic intervention involving coronary stent deployment and intra-aortic balloon pump (IABP) support to optimize coronary perfusion, the patient experienced multiple adverse events, including coronary arterial rupture, myocardial infarction, and cardiogenic shock. These complications culminated in progressive circulatory compromise, multiple organ dysfunction syndrome. The patient unfortunately passed away 3 days later.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis case details the presentation of a 42-year-old male patient who developed acute myocardial infarction (AMI) and ventricular tachycardia (VT) subsequent to multiple blunt traumas, with significant chest involvement. The patient's clinical course, despite comprehensive therapeutic intervention, underscores the fundamental importance of prompt diagnosis and integrated management in trauma patients with suspected cardiac involvement. The occurrence of AMI following blunt chest trauma represents an infrequent complication. Epidemiological data from postmortem analyses indicate cardiac injury in 20% of blunt chest trauma cases, with coronary vessel involvement documented in less than 2% of cases [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Coronary dissection is most common in the left anterior descending( LAD) artery (76%), followed by the right coronary (12%) and circumflex (6%)[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The LADʼs susceptibility is due to its anterior position, proximity to the sternum, and longer course, making it prone to shear stress from blunt trauma.Notably, while left main coronary artery dissection is exceptionally rare (\u0026lt;\u0026thinsp;1% of traumatic coronary injuries), its occurrence has been pathologically confirmed through intravascular ultrasound, demonstrating how high-energy trauma can induce longitudinal intimal tears even in proximal coronary segments [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].The underlying mechanisms of trauma-induced AMI include various pathological processes, including coronary vessel disruption, thrombotic events, atherosclerotic plaque destabilization, aneurysm formation, and arterial dissection [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The observed complete occlusion of the left main coronary artery in this case represents a particularly rare manifestation.\u003c/p\u003e \u003cp\u003eThe diagnostic process for AMI in the context of blunt chest trauma poses substantial clinical challenges. Primary cardiac manifestations may be obscured by concurrent injuries such as costal fractures or pulmonary contusions, potentially resulting in delayed recognition of cardiac sequelae\u0026mdash;a critical determinant of clinical outcomes. In the present case, initial electrocardiographic evaluation revealed ventricular tachycardia, a significant arrhythmia associated with, but not pathognomonic for, AMI. Classical myocardial infarction indicators emerged in the subsequent hours. The patient's AMI presentation was attributed to traumatic coronary artery dissection, necessitating immediate therapeutic intervention and intensive monitoring.\u003c/p\u003e \u003cp\u003eThe implementation of percutaneous coronary intervention (PCI) in such cases presents significant therapeutic considerations [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. While this intervention provides essential hemodynamic support, it carries inherent risks, particularly regarding hemorrhagic complications. The patient may experienced substantial bleeding following heparin administration during PCI, highlighting the necessity for meticulous evaluation of anticoagulation risks and benefits in trauma patients.\u003c/p\u003e \u003cp\u003eCoronary angiography and subsequent intervention remain essential components in the management of trauma-induced AMI, serving both diagnostic and therapeutic objectives. Angiographic evaluation in this case demonstrated complete left main coronary occlusion, which was addressed through angioplasty. However, identification and management of the primary lesion are insufficient to prevent mortality.\u003c/p\u003e \u003cp\u003eThis clinical presentation emphasizes the necessity for enhanced vigilance in patients with blunt chest trauma. Cardiac injury may be masked by more apparent traumatic manifestations, such as pulmonary contusions or skeletal fractures. Consequently, maintaining a high index of suspicion for cardiac complications and initiating prompt cardiac enzyme analysis and electrocardiographic evaluation are essential for optimal therapeutic timing [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe management of posttraumatic AMI and VT necessitates a sophisticated, multidisciplinary therapeutic strategy. While significant advancements have been made in interventional cardiology and critical care medicine, clinical outcomes continue to demonstrate considerable variability. Additional clinical research initiatives are essential to enhance therapeutic protocols and optimize patient outcomes in these medically complex scenarios.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAMI \u0026nbsp;Acute myocardial infarction\u003c/p\u003e\n\u003cp\u003eVT \u0026nbsp; Ventricular tachycardia\u003c/p\u003e\n\u003cp\u003eECG \u0026nbsp;Electrocardiogram\u003c/p\u003e\n\u003cp\u003eVA-ECMO Veno-arterial extracorporeal membrane oxygenation\u003c/p\u003e\n\u003cp\u003eIABP \u0026nbsp;Intra-aortic balloon pump\u003c/p\u003e\n\u003cp\u003ePCI \u0026nbsp; Percutaneous coronary intervention\u003c/p\u003e\n\u003cp\u003eLAD \u0026nbsp;left anterior descending\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":" \u003cp\u003eThis case report was conducted in accordance with the standards of the Declaration of Helsinki.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003e This case report is a retrospective study, and the patient unfortunately passed away and was unable to sign the informed consent form. The ethical review of this article was approved by the Ethics Committee of the First Affiliated Hospital of Guangxi Medical University.\u003c/p\u003e \u003ch2\u003eClinical trial number\u003c/h2\u003e \u003cp\u003enot applicable.\u003c/p\u003e \u003ch2\u003eCompeting interests\u003c/h2\u003e \u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e \u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eNot applicable.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eK.L. and C.Q. wrote the main manuscript text and prepared Figs. 1, 2, 3, and 4. All the authors reviewed the manuscript\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e \u003cp\u003eNot applicable.\u003c/p\u003e\u003ch2\u003eData availability\u003c/h2\u003e \u003cp\u003eAll the data and materials described in the manuscript are not publicly available because the containing information could compromise the privacy of the patient. K.L. should be contacted if someone wants to request the data on a reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003ePr\u0026ecirc;tre R, Chilcott M. Blunt trauma to the heart and great vessels. N Engl J Med. 1997;336:626\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShao Y, Xia W, Zhang C, Wang X. Bilateral coronary dissection after blunt thoracic trauma: a case report. Can J Cardiol. 2012;28(515):e1\u0026ndash;2.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChun JH, Lee SC, Gwon HC, et al. Left Main coronary artery dissection after blunt chest trauma presented as acute myocardial infarction: assessment by intravascular ultrasound: a case report. J Korean Med Sci. 1998;13:325\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJanella BL, Pinto RJ, Pena HP, Carneiro JG, Sousa MR, Andrade MA Jr. Acute myocardial infarction related to blunt thoracic trauma. Arq Bras Cardiol. 2006;87(6):e239\u0026ndash;42.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLin YC, Chang YS, Chen MS, Ho WJ, Kuo CT, Chang CJ. Effective myocardial salvage with percutaneous coronary intervention in late diagnosed acute post-traumatic ST-elevation myocardial infarction. J Emerg Med. 2012;42(1):28\u0026ndash;35.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOrliaguet G, Ferjani M, Riou B. heart blunt trauma Anesthesiology. 2001;95(2):544\u0026ndash;48.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-cardiothoracic-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jcts","sideBox":"Learn more about [Journal of Cardiothoracic Surgery](http://cardiothoracicsurgery.biomedcentral.com)","snPcode":"13019","submissionUrl":"https://submission.nature.com/new-submission/13019/3","title":"Journal of Cardiothoracic Surgery","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Blunt chest trauma, ventricular tachycardia, myocardial infarction","lastPublishedDoi":"10.21203/rs.3.rs-5617157/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5617157/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eIntroduction\u003c/h2\u003e \u003cp\u003eBlunt chest trauma resulting in cardiac injury is a significant cause of mortality in trauma patients. Among the most critical sequelae, acute myocardial infarction (AMI) and ventricular tachycardia (VT) require prompt medical attention because of their potentially life-threatening nature. This case report examines the clinical progression and therapeutic approach in a patient who presented with these severe cardiac complications.\u003c/p\u003e\u003ch2\u003eCase presentation\u003c/h2\u003e \u003cp\u003eA 42-year-old male was admitted with significant sternal pain, acute respiratory compromise, and substantial hemorrhage from cranial and facial injuries following a traumatic event. Initial clinical evaluation revealed elevated cardiac biomarkers and electrocardiographic abnormalities, resulting in the diagnosis of acute myocardial infarction (AMI) complicated by ventricular tachycardia (VT).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThis investigation underscores the paramount importance of expeditious diagnosis and intervention for acute myocardial infarction (AMI) and ventricular tachycardia (VT) in patients with blunt chest trauma. These findings demonstrate that even with comprehensive therapeutic intervention, severe cardiac complications may result in adverse outcomes.\u003c/p\u003e","manuscriptTitle":"Race-over time: a critical case of acute myocardial infarction and ventricular tachycardia following blunt chest trauma","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-28 19:36:21","doi":"10.21203/rs.3.rs-5617157/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Accepted","date":"2025-05-11T16:25:47+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-28T08:03:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"294936035107370864453848479793218223695","date":"2025-04-24T20:20:04+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-23T12:09:10+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"331145319216840883223719953382004675455","date":"2025-04-23T11:24:22+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-04-22T18:56:57+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-16T06:01:13+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Cardiothoracic Surgery","date":"2025-04-16T00:46:47+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-cardiothoracic-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jcts","sideBox":"Learn more about [Journal of Cardiothoracic Surgery](http://cardiothoracicsurgery.biomedcentral.com)","snPcode":"13019","submissionUrl":"https://submission.nature.com/new-submission/13019/3","title":"Journal of Cardiothoracic Surgery","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9c41715a-25df-4682-90b0-fc590bae3fcd","owner":[],"postedDate":"April 28th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-06-02T16:07:37+00:00","versionOfRecord":{"articleIdentity":"rs-5617157","link":"https://doi.org/10.1186/s13019-025-03470-2","journal":{"identity":"journal-of-cardiothoracic-surgery","isVorOnly":false,"title":"Journal of Cardiothoracic Surgery"},"publishedOn":"2025-05-30 15:57:00","publishedOnDateReadable":"May 30th, 2025"},"versionCreatedAt":"2025-04-28 19:36:21","video":"","vorDoi":"10.1186/s13019-025-03470-2","vorDoiUrl":"https://doi.org/10.1186/s13019-025-03470-2","workflowStages":[]},"version":"v1","identity":"rs-5617157","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5617157","identity":"rs-5617157","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}