Friday, January 18, 2013

ST-segment elevation myocardial infarction after drowning

ST-segment elevation myocardial infarction after drowning

Authors: Hesham Rashad Omar, Madhu Shree Gundavaram, Ehab El-Khabiry, Yaseen Ali, and Enrico Mario Camporesi
Journal: Internal and Emergency Medicine (Italian Society of Internal Medicine)

Very interesting case study.  The morbidity and mortality from drowning stems from the primary hypoxic injury and can been seen in the end organ damage of patients, the most worrisome and devastating of which is usually encephalopathy.  This case highlights the cardiovascular effects of hypoxia in a patient who we would otherwise not expect to see it in.  The paper tells of a 16 year old patient who was brought in after a drowning injury in which the initial ECG showed ST segment elevations consistent with inferior MI.  The patient was then taken to the cath lab, but cath was cancelled due to resolving elevations in a repeat ECG;  eventual troponins were positive.  Unfortunately the patient continued to decompensate from there on out until he was diagnosed as brain dead.  

As we all know, MI can be the inciting event for drowning injury, but in a patient this age we can assume that it was an indicator of end organ injury.  I would have like to have seen a post-mortem report to determine if there was any cardiac abnormalities, but all in all an interesting case.