EXTENSIVE ANTERIOR WALL ST ELEVATED MYOCARDIAL INFARCTION FOLLOWING STEERING WHEEL IMPACT AND BLUNT CHEST TRAUMA IN A ROAD TRAFFIC ACCIDENT: A RARE CASE REPROT

Background: Blunt trauma chest may rarely lead to acute myocardial infarction. Shear force generated from trauma causes tearing, laceration of coronary vascular intima and results in intraluminal thrombosis. Left anterior descending (LAD) artery is the most common to be involved secondary to its proximity to anterior chest wall. Case Presentation: We report a case of 38year old hypertensive male presented in emergency room with complaints of left sided chest pain & diaphoresis for one hour following trauma to his chest from steering wheel following a collision between two four wheeler. During primary survey as per ATLS guideline 12 ECG revealed acute extensive anterior wall STEMI. Other associated injuries were left frontal non hemorrhagic contusion, bilateral minimal pneumothorax, multiple bilateral rib fractures, mild hemoperitoneum with small hematoma in retroperitoneum and serosal surface of stomach. Urgent coronary angiography done by cardiologist on call and patient was diagnosed with single vessel coronary artery disease involving LAD with severe systolic LV dysfunction. Percutaneous transmural coronary angioplasty (PTCA) was done by a drug eluting stent in LAD. Conclusion: An emergencyphysician should consider cardiac complications in patients with chest trauma including myocardial infarction, early diagnosis of which is critical to save the myocardium.Any delay in diagnosis can be detrimental. What we already know? There are quite a few case reports that already mentioned about possibility of acute myocardial infarction after blunt chest trauma following road traffic accident secondary to intimal laceration of coronary artery and intraluminal thrombosis. Most coomonly left anterior descending artery is involved. What this paper adds?This is rare case report of acute & extensive anterior wall myocardial infarction secondary to single vessle coronary artery involvement after blunt chest trauma by steering wheel in a road traffic accident. We specifically points towards the fact that noobvious Clinical guideline to manage these kind of cases mentioned in literature.Hence proper clinical guidelines to manage such kind of cases. Also, in acute myocardial infarction post blunt trauma chest, PCI seems to be a better option than thrombolysis keeping in mind of other injuries.