Subepicardial Hematoma of the Left Ventricle Mimicking Acute Anterior Myocardial Infarction

A 63-year-old male with hypercholesterolemia was admitted to the emergency department complaining of a 12-hour persisting typical central chest pain. He had experienced a blunt chest trauma while practicing judo 6 weeks earlier. On admission, the 12-lead ECG was consistent with acute anterior ST-segment elevation myocardial infarction (STEMI), and the patient received loading doses of aspirin, prasugrel, and unfractioned heparin. The urgent coronary angiogram (CA) showed an occlusion of the mid-left anterior descending (LAD) artery, with retrograde collateralization arising from the first diagonal branch, and absence of significant lesions in the left circumflex and right coronary arteries (Movie I in the online-only Data Supplement). Percutaneous coronary intervention to the LAD was attempted without possibility to access the distal LAD beyond the occlusion site, suggesting a chronic total occlusion (Movie II in the online-only Data Supplement). The procedure was stopped because the patient became symptom free without hemodynamical compromise. The final CA showed persisting occlusion of the mid-LAD and absence of coronary perforation (Movie III in …