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(Circulation. 2000;102:713.)
© 2000 American Heart Association, Inc.

Images in Cardiovascular Medicine

Myocardial Infarction After Dog Bite

Christoph Scharf, MD; Urs Widmer, MD

From the Department of Medicine, University Hospital, CH-8091 Zürich, Switzerland.

Correspondence to Christoph Scharf, MD, Division of Cardiology, Department of Medicine, University Hospital, CH-8091 Zürich, Switzerland. E-mail christoph.scharf@dim.usz.ch

A36-year-old man who had undergone splenectomy several years earlier as a result of trauma was admitted with malaise and scattered hemorrhagic lesions on his nose (Figure, A). Two days earlier, his dog had bitten him. The next day, he developed chills, watery diarrhea, and vomiting. On admission, the patient complained of chest discomfort. On physical examination, his core temperature was 37.8°C, his blood pressure was 80/60 mm Hg, his heart rate was 90 beats/min, and his respiration was 10 breaths/min, with normal cardiopulmonary auscultation. At the site of the dog bite, a discrete lesion was visible, without any sign of infection (Figure, B). The surface ECG showed ST elevation in the inferolateral leads (Figure, C). Laboratory examination revealed a white blood cell count of 32 400 cells/µL, a C-reactive protein level of 549 mg/dL, a creatinine level of 268 µmol/L, disseminated intravascular coagulation with thrombocytopenia of 31 000 cells/µL, and D-dimers of 10.2 mg/L. Creatine kinase levels rose from 788 IU/L to 3029 IU/L after 6 hours, and they peaked at 3306 IU/L after 12 hours. The troponin-I concentration rose from 1.2 µg/L to 108 µg/L after 6 hours and declined to 38 µg/L on the second hospital day.

View larger version (152K): [in this window] [in a new window]   Figure 1. A, Hemorrhagic lesions on the nose made the patient seek medical attention. B, Easily overlooked bite wound had no signs of local infection. C, ECG demonstrated transmural ischemia in the inferolateral leads. D, Polymorphonuclear leukocyte contains intracytoplasmic rods (arrow).

Diagnostic procedures included a thorough examination of the peripheral . . . [Full Text of this Article]

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