Acute Myocardial Infarction Fallowing Blunt Chest Trauma-the Need for Third-Line Investigations in Medico-Legal Practice

Abstract

Acute myocardial infarction is relatively uncommon among the young adults. Blunt trauma to chest is one rare mechanism of acute myocardial infarction specially among young adults.  A 35-year-old male had sustained among other injuries, a blunt impact on the left side of his front chest and abdomen when his motor bike collided with a van from behind. ECG on admission to the accident and emergency unit showed ST segment elevations from V2-V6 together with elevated CPK and periodic changes of Troponin T. He was managed as for acute myocardial infarction. Streptokinase was not given due to high risk of bleeding following trauma. He had an uneventful recovery. Myocardial infarction could be precipitated by damage to coronary arteries due to non-penetrating blunt impact on the chest, the possible mechanisms being coronary artery dissection, intimal tears, sub-intimal hemorrhages, intra-luminal thrombosis and spasm. CT/MRI guided coronary angiography is considered the best investigation to exactly identify the aetiology. Blunt impact may also cause myocardial contusions which can also lead to an outcome similar to a myocardial infarction. The objective of this case report is to highlight that trauma and infarction (specially in a person with pre-existing ischaemia) will pose a wide array of medico-legal issues some of which are difficult to be answered by the clinician or the pathologist with certainty.