Gunshot injuries may cause acute myocardial infarction due to coronary artery damage, embolization of a bullet or pellet, and direct myocardial damage.

A 46-year old man was brought to the emergency room with pellet injuries after being shot. Physical examination revealed a regular-edged and roundshaped wound with a diameter of 4 mm located 2 cm above the left nipple. The electrocardiogram showed marked ST segment elevation in the inferior leads and ST-segment depletion in V2, V3, V4, V5, DI, and AVL. Posteroanterior chest radiography disclosed a radiopaque round foreign body at the margin of the cardiac silhouette. Echocardiography showed posterolateral hypokinesia and minimal pericardial effusion. The patient was transferred to the operating room with the diagnosis of coronary injury and myocardial damage. The exploration revealed myocardial rupture on the anterior wall of the right ventricle. The damage was repaired and the patient was discharged on the postoperative 10 th day.

An early diagnosis of cardiac injury can be made with an electrocardiogram obtained in emergency department. ©2007, Fırat University, Medical Faculty