ABSTRACT
Myocardial ischemia results from an abrupt decrease in the myocardial oxygen supply/demand relationship. This may result from rupture of pre-existing atherosclerotic plaque or an acute increase in demand in a patient with significant pre-existing coronary artery disease (CAD) (1). In the trauma setting, coronary vasospasm and coronary emboli may occur, along with direct trauma to the heart, resulting in ischemia in the absence of known pre-existing coronary disease (2). However hypoperfusion of myocardium supplied by coronary arteries with pre-existing lesions is the predominant ischemic mechanism. Additionally, coronary spasm, in response to a variety of stimuli, plays a variable role in the development of myocardial ischemic episodes when superimposed upon CAD (3).
