[Myocardial infarction during attempted suicide]

Abstract

History and clinical findings: A 64-year-old man, known to be in a depressive state, attempted suicide by cutting hist wrist, having previously stopped his antidepressant medication. He reported having for several weeks had chest pain during exercise.

Investigations: Transection of multiple flexor tendons, of the median nerve on both wrists and of the right radial artery were diagnosed. The electrocardiogram showed signs of an acute inferoposterolateral ST-elevation myocardial infarction. Coronary angiography showed an occlusion of the right coronary artery.

Diagnosis, treatment and clinical course: After an initial local surgical dressing of the cut wrist, a percutaneous coronary intervention was performed with recanalisation and stenting of the right coronary artery. After ventricular defibrillation, the patient was transferred to the intensive care unit, where the course was complicated by heart failure and aspiration. Operative reconstruction of the tendons and nerves was done later.

Conclusion: The occurrence of an acute myocardial infarction in relation to an attempted suicide suggests causal relationship (acute stress as trigger). The silent course could be an effect of an overwhelmed sensory system.