Acute myocardial infarction following right coronary artery dissection due to blunt trauma

Abstract

Despite the frequent occurrence of blunt chest trauma, associated cardiac injuries are relatively rare. The most common presentation of blunt cardiac injury is benign arrhythmia (e.g., sinus tachycardia), followed in decreasing frequency by increasingly severe arrhythmias and finally physically evident injuries to the heart muscle, the conducting system, cardiac valves, and/or coronary vessels. Here we present an unusual case of a patient who sustained a right coronary artery dissection and associated acute myocardial infarction following a motor vehicle crash.

Did heart asymmetry play a role in the evolution of human handedness?

“…The study did not include questions to physicians concerning blunt thorax violence. Blunt chest trauma is a commonly seen problem in traumatology (Mubang et al 2016). In addition to rib fractures, spine fractures, pulmonary contusions, blunt cardiac injuries such as traumatic valvular and coronary artery changes have also been reported (Mubang et al 2016).…”

“…Qualified physicians estimations of the mortality, due to left and right thorax injury, are in accordance with that. Blunt cardiac violence may be deadly (Mubang et al 2016), possibly adding one more advantage of right-handedness. Right handers might be more apt killers, since they have their dominant hand closer to the opponent's heart, and since they might develop more force towards the left thorax of the opponent.…”

Traumatic Right Coronary Artery Dissection as a Cause of Inferior Wall ST-Elevation Myocardial Infarction

“…Common causes of an inferior wall myocardial infarction (MI) include atherosclerotic disease secondary to hypertension and diabetes, coronary artery spasms and inflammatory systemic diseases. However, traumatic coronary artery dissection from blunt thoracic trauma, leading to an acute MI has a low incidence [1,2]. In patients who sustain a chest trauma and develop persistent chest pain without any signs of hemopericardium, haemothorax or pneumothorax, it is crucial to have a high index of suspicion for coronary artery trauma.…”

“…The diagnosis may be especially difficult in the absence of an electrocardiogram (EKG) because chest pain following a blunt thoracic injury can be interpreted as being secondary to chest wall contusion, rib fractures, or it may be overlooked in the presence of other injuries. EKG changes such as hyperacute T-waves in the distribution of the affected territory, which might evolve into STsegment elevation, are suggestive of a coronary pathology [1]. Hence, EKG should be performed in all patients with thoracic trauma.…”

“…Hence, EKG should be performed in all patients with thoracic trauma. Amongst the coronary arteries, right coronary artery (RCA) is less frequently injured in blunt cardiac trauma, with left anterior descending (LAD) artery being the most injured [1,2]. We present a case of a 41-year-old male who presented with a traumatic RCA dissection leading to inferior wall ST-elevation myocardial infarction (STEMI).…”