TRAUMATIC CORONARY

Heart-attack caused by blunt chest trauma during a motor vehicle accident has been well-documented, but remains sufficiently rare that small series are still reported in the medical research literature[1].

PRACTICE POINT Driver heart-attack very rarely causes serious-injury traffic accidents but is often fatal.

Risk of heart-attack causing traffic accidents has probably been overestimated. Elderly drivers with coronary heart disease were found to have risk of injury significantly increased over their peers only if they also had diabetes[2].

In a study of more than 200 episodes of loss of consciousness preceding motor vehicle accidents, driver heart-attack was usually fatal, but rarely resulted in serious injury[3]. Other researchers have proposed this is because warning symptoms permit evasive action[4].

When heart-attack and serious injury do coexist, diagnosis may be difficult but medicolegally important. If the driver survives a few hours, human cardiac Troponin I, an enzyme produced only by heart muscle, can be measured in the blood and is highly specific for heart-attack, even in the presence of extensive bodily injury[5].

PRACTICE POINT Recent technical advances have improved the POTENTIAL ability to diagnose co-existent heart-attack and seriou bodily injury, both before and after death.

Recent refinement of technique means that forensic autopsy can now distinguish heart-attack from other natural and violent causes of death with 70-80% certainty[6].

However, neither of these refinements is routinely available in hospital laboratories.

Copyright © 2008 Electronic Handbook of Legal Medicine