An Uncommon Cause of ST-Segment Elevation Myocardial Infarction

Figure 1. Initial Electrocardiogram Initial electrocardiogram with sinus rhythm and ST-segment elevation (red arrows) in leads V2 to V6 with associated Q waves suggestive of anterolateral ST-segment elevation myocardial infarction.

Figure 2. Chest X-Ray Chest X-ray without acute cardiopulmonary disease and no evident bone fractures.

Figure 3. Coronary Angiography (A) Subtotal occlusion of mid left anterior descending artery with Thrombolysis In Myocardial Infarction flow grade 1 and filling defect suggestive of thrombus (white arrow) (Video 1). (B) After performing aspiration thrombectomy to the mid left anterior descending artery (white arrow) and providing 200 μg of intracoronary nitroglycerin, a long and smooth tubular lesion persisted (green arrow), which raised suspicion for external compression given the history of recent blunt chest trauma. (C) Final result (Video 3) after intravascular ultrasound-guided stenting of the mid left anterior descending artery (white arrow). (D) Normal right coronary artery.

Figure 4. Intravascular Ultrasound (A to C) Intravascular ultrasound frames showing extensive spiral intramural hematoma (∗) of the mid to distal left anterior descending artery with lumen compromise (Video 2). (D) After Intravascular ultrasound-guided stenting of mid left anterior descending artery with compressed residual intramural hematoma (arrow).

Figure 5. Ventricular and Aortic Angiography Ventricular diastolic (A) and systolic (B) frames with evidence of distal inferoapical and anteroapical akinesis (white arrows) corresponding with the wrap-around left anterior descending artery territory and mildly reduced overall systolic function (ejection fraction 40% to 45%). (C) Ascending aorta angiography without evidence of dissection or aneurysm

Figure 6. Transthoracic Echocardiogram Post-Myocardial Infarction Day 1 Two-chamber diastolic (A) and systolic (B) frames showing severe hypokinesis of antero-apical, infero-apical, and mid anteroseptal walls. Four-chamber diastolic (C) and systolic (D) frames with intravenous contrast showing severe hypokinesis of the septal and lateral apical walls. No evidence of left ventricular thrombi, pericardial effusion, or major valvulopathies.