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Case Reports
. 2021 Jul 31;29(1):106.
doi: 10.1186/s13049-021-00911-4.

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

Mathew Brun  1 , Shane Brun  2 , David Pearson  3 , Martin Wullschleger  4
Affiliations
Case Reports

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

Mathew Brun et al. Scand J Trauma Resusc Emerg Med. .

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.

Keywords: Anticoagulation; Haematoma; Mimic; Multi-trauma; Polytrauma; Pseudotamponade; STEMI; Tamponade; Thrombolysis; Trauma.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Case timeline
Fig. 2
Fig. 2
ECG showing STE > 1 mm in leads II, III and aVF with STE III > II and subtle STD in I suggestive of RCA occlusion
Fig. 3
Fig. 3
Bizarre narrow complex tachycardia with large U waves in lateral leads and prolonged QT
Fig. 4
Fig. 4
Telemetry showing progress from sinus bradycardia, to severe bradycardia then sinus pause
Fig. 5
Fig. 5
Coronal CT sections showing a large retroperitoneal haematoma, duodenal compression and gastric distension and a distorted left ventricle
Fig. 6
Fig. 6
Parasternal long axis view showing the haematoma compressing the posterior wall of the LV
Fig. 7
Fig. 7
Short axis view showing the haematoma compressing both posterior and inferior walls of the LV
See this image and copyright information in PMC

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