The way to a man’s heart is through his stomach: a case of myocardial infarction mimic and pseudo-tamponade in a polytrauma patient

• Main Authors: Mathew Brun, Shane Brun, David Pearson, Martin Wullschleger
• Format: Article
• Language: English
• Published: BMC 2021-07-01
• Series: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
• Subjects: Trauma; Polytrauma; Multi-trauma; Anticoagulation; Thrombolysis; Haematoma
• Online Access: https://doi.org/10.1186/s13049-021-00911-4

Abstract Background There exists a therapeutic conflict between haemorrhage control and prevention of thromboembolic events following polytrauma and complications are not uncommon. Such opposing therapies can result in unexpected pathophysiology and there is a real risk of misdiagnosis resulting in harm. This case presents a previously unreported complication of prevention and management of thromboembolism- STEMI (ST elevation myocardial infarction) and tamponade mimic secondary to retroperitoneal haematoma. Case presentation We present a 50-year-old male polytrauma patient who following treatment for presumed pulmonary embolus demonstrated classical clinical findings of myocardial infarction and pericardial tamponade secondary to a retroperitoneal haematoma. This is an event not previously reported in the literature. The risk of adverse outcome by management along the standard lines of STEMI (ST elevation myocardial infarction) was averted through awareness for alternative aetiology via a multi-team approach which resulted in percutaneous drainage of the haematoma and complete resolution of symptoms. Conclusions This manuscript highlights the therapeutic conflict between haemorrhage control and prevention of thromboembolic events in critically injured, the importance of high index of suspicion in this patient cohort and the benefits of multidisciplinary decision making in the complex patient through a not previously published pathophysiologic phenomenon.