Abstract
We report a case of blunt cardiac injury with scintigraphic evidence of a mismatch of perfusion metabolism. A healthy, 37 year-old man was brought to our department after blunt trauma to his chest by heavy building material. About 20 minutes after admission he suffered ventricular fibrillation (VF), followed by cardiac arrest. He was resuscitated but spontaneous circulation, VF, pulseless ventricular tachycardia, or torsade de pointes recurred temporarily after about 30 min. He was resuscitated again and admitted to our intensive care unit. A dual myocardial scintigram was obtained on day 7 with thallium 201 (Tl) and 123I-beta-methyl iodophenyl pentadecanoic acid (BMIPP). The Tl image showed a scintigraphic defect only in a small area of the apex of the heart, while the BMIPP image showed defects in the larger area of the apex, ventricular septum, and inferior wall. He was diagnosed with a mismatch of perfusion metabolism. He was discharged uneventfully on day 16. A follow-up, dual myocardial scintigram on day 49 showed the scintigraphic defects had disappeared everywhere except the small area at the apex. We believe that the mismatch of perfusion metabolism in this case resulted from blunt external force and caused his life-threatening, premature ventricular contractions.
