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Abstract

Background: Blunt chest trauma (BCT) is a rare yet potentially fatal cause of acute coronary syndrome (ACS), including ST-segment elevation myocardial infarction (STEMI). Although it may occur with ischemic heart disease (IHD), it can also occur in young adults without cardiovascular risk factors. Trauma-related STEMI presents a diagnostic challenge because cardiac symptoms may be masked by concomitant traumatic injuries.

Case Summary: A 23-year-old man, a heavy smoker, was admitted following a motorcycle accident with direct anterior chest impact against the handlebar. He reported epigastric chest pain that worsened during observation. He was initially admitted for orthopedic observation to rule out skeletal injury. As his chest pain intensified and dyspnea developed, an ECG revealed late-onset STEMI. Given his age and atypical presentation, ACS was not initially suspected. Cardiac computed tomography using a triple rule-out protocol demonstrated 100% acute obstruction of the left anterior descending (LAD) artery. He underwent emergent primary PCI, with successful restoration of coronary blood flow.

Conclusion: This case illustrates how blunt chest trauma can obscure ACS, leading to delayed recognition of STEMI. Initial diagnostic uncertainty, including myocardial contusion or myocarditis, and the absence of early ECG assessment postponed definitive treatment. Once ACS was confirmed, prompt anticoagulation therapy and PPCI were life-saving. This report underscores the importance of early ECG screening in adult trauma patients with chest pain, regardless of age. Blunt thoracic trauma may precipitate coronary plaque rupture or acute thrombosis, making clinical vigilance and early cardiac evaluation essential to prevent delayed intervention. 

Keywords 

Chest injuries; Acute coronary syndrome; ST elevation myocardial infarction; coronary occlusion; Percutaneous coronary intervention 

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