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European Heart Journal Advance Access originally published online on January 19, 2008
European Heart Journal 2008 29(13):1652; doi:10.1093/eurheartj/ehm627
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

Hunting rifle shot to the chest: a rare cause of myocardial infarction

Alban-Elouen Baruteau, Raphaël Pedro Martins and Dominique Boulmier*

Department of Cardiology, CHU Pontchaillou, University Hospital, 2 rue Henri Le Guilloux, 35033 Rennes, France

* Corresponding author. Tel: +33 299 282 525, Fax: +33 299 282 510, Email: dominique.boulmier{at}chu-rennes.fr

A 46-year-old man without cardiovascular risk factors was shot in the chest with a hunting rifle 1 month before this evaluation (Panel A). He underwent emergency surgery for haemorrhagic shock because of right and left ventricular tears. Upon his discharge from the intensive care unit, electrocardiographic changes consistent with apico-lateral infarction were noted, and trans-thoracic echocardiography revealed the presence of apical akinesia, with a left ventricular ejection fraction at 45%. Coronary angiograms (Panel B) showed a short 50% stenosis of the distal left anterior descending (LAD) coronary artery, followed by post-stenotic aneurysmal dilatation (arrow) and normal coronary flow. On 64-slice computed tomography (Panels C and D), 253 rifle pellets were observed in the mediastinal region; of which five were lodged in the interventricular septum and one was in contact with the distal LAD, adjacent to the stenosis (circle). We hypothesized two possible mechanisms: (i) a blast effect with dissection, thrombosis, or both, secondary to intimal tear; (ii) vascular stenosis secondary to oedema or parietal haematoma by myocardial contusion. The patient was placed on a regimen of anti-platelet agents, beta-adrenergic blocker, angiotensin-converting enzyme inhibitor, and statin, and has remained free of cardiovascular complication at 1 year of follow-up.

Panel A. Postero-anterior chest roentgenogram. Innumerable rifle pellets are visible, mostly in the precordial area and left lower lung field.

Panel B. Selective angiography of the left coronary artery in the right anterior oblique projection. Innumerable rifle pellets overlie the precordial region. See text for details.

Panel C. 64-slice computed tomography (long axis view). See text for details.

Panel D. 64-slice computed tomography (maximum intensity projection and volume rendering). See text for details.

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This Article
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29/13/1652    most recent
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