Blunt cardiac injury with scintigraphic perfusion–metabolism mismatch

Abstract

Patient: A healthy 37-year-old man who bruised his chest with a steel frame developed ventricular fibrillation, pulseless ventricular tachycardia, and temporary torsade de pointes, and was resuscitated with emergency medical treatment. Thallium 201 scintigraphy 7 days later revealed a defect only in a small area of the apex, whereas 123I-beta-methyl iodophenyl pentadecanoic acid scintigraphy showed defects in a larger area of the apex, ventricular septum, and inferior wall, indicating perfusion-metabolism mismatch. Follow-up dual myocardial scintigraphy on day 49 showed that the scintigraphic defects persisted only at a small area of the apex. Conclusion: Blunt external force appeared to have caused perfusion-metabolism mismatch and subsequent life-threatening arrhythmias in this patient.