Coronary artery dissection after blunt chest trauma

Shamsi, Fahad; Tai, Javed; Bokhari, Saira

doi:10.1136/bcr-2013-203520

Cited by 4 publications

(4 citation statements)

References 4 publications

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“…Many studies describe MI as a direct result of cardiac injury due to trauma, most often blunt trauma. This often involves traumatic dissection of coronary arteries [2][3][4]. However, MI in trauma is not always associated with direct damage to the coronary arteries or myocardium.…”

Section: Discussionmentioning

confidence: 99%

“…However, due to an aging demographic, the United States trauma population is becoming older, with greater chronic comorbidity [1]. Much of the literature regarding myocardial infarction (MI) in trauma discusses the effect of direct cardiac damage from chest trauma, but trauma patients can suffer from demand-related ischemic heart disease as well [2][3][4]. Trauma, like surgery, can cause physiologic stress which could potentially lead to cardiac ischemia and MI.…”

Section: Introductionmentioning

confidence: 99%

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Analysis of Predictors of Myocardial Infarction in Trauma With Development of a Trauma Cardiac Risk Index

Culhane¹,

Mangold²,

Freeman³

2021

Cureus

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Study objective: Trauma has historically been considered a disorder of the young and healthy, with a low risk of cardiac ischemia; hence most research on myocardial infarction in trauma has focused on direct cardiac damage from blunt chest trauma. However, the age and comorbidity of trauma patients are increasing, making the trauma population more vulnerable to myocardial infarction (MI). Cardiac risk assessment has emphasized morbidity and mortality in an elective surgical setting, but it is also important in acute trauma. Our study analyzes the risk factors for MI in a trauma population to create a scoring system to predict the risk of MI. Design: Retrospective cohort analysis of a national trauma registry over a five-year period. Potential predictors of MI in trauma patients were identified and tested with univariate and multivariate statistics. A numerical score was created to predict the risk of MI based on these criteria. Setting: The National Trauma Data Bank (NTDB) is a large registry of selected trauma centers in the United States. Data include demographic, injury, treatment, and outcome variables pertaining to the index admission of each patient. The institutions range from community hospitals through level 1 trauma centers. The time period is the entire inpatient hospital admission from arrival from the field, through the emergency department, ICU, and floor up to discharge. Patients: 3,437,959 trauma patients aged 18 years and older from various US trauma centers. 62.8% were male. The median age is 50 years with a standard deviation of 21.25. The median Injury Severity Score is 9 with a standard deviation of 9.04. Measurements: Demographic, traumatic, and comorbidity variables were collected from the NTDB. The primary outcome was MI during the initial trauma admission. Multivariate analysis was performed with logistic regression. Main results: Over 8010 (0.23%) suffered an MI. The strongest risk factors for MI were a history of MI with an adjusted odds ratio (OR) of 7.0, and angina with an OR of 3.4. A procedure under general anesthesia (GA) conferred an OR of 2.3. Minor risk factors included torso injury and 10-year age interval over 50, both with an OR of 1.7, a 20-point interval of the Injury Severity Score (ISS) with OR 1.6, male gender with OR of 1.5, and various chronic disease comorbidities with OR ranging from 1.4 to 1.9. A Trauma Cardiac Risk Index (TCRI) was derived from these risk factors. The model showed good discrimination with a C statistic of 0.85. Conclusions: Overall the trauma population has a low risk of MI. However, the risk is much higher for older patients with chronic comorbidity. The TCRI can be used to assess cardiac risk in trauma patients to help direct monitoring, testing, and risk reduction measures to those at the highest risk.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Analysis of Predictors of Myocardial Infarction in Trauma With Development of a Trauma Cardiac Risk Index

Culhane¹,

Mangold²,

Freeman³

2021

Cureus

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“…Andrew R Elms et al reported involvement of Left Circumflex coronary artery by penetrating pellets from gunshot resulting in Myocardial Ischemia. 15 Cases of blunt chest trauma resulting in dissection of LAD have been reported more in literature managed either conservatively 16 or by angioplasty. 17,18…”

Section: Discussionmentioning

confidence: 99%

Acute Myocardial Infarction Due to Knife Injury – A Case Report

Hameed¹

2021

Pak Heart J

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Acute Myocardial Infarction is usually a sequela of atherosclerotic process but can result from some rare causes as well. Trauma to the chest wall either blunt or penetrating can cause such a mishap. Case of a young man is described who sustained STEMI due to severing of Left anterior descending coronary artery by a penetrating knife injury, stabbed on the left side of the chest during a scuffle with bandits. Being resident of a remote area of a very poor neighboring country, the victim couldn’t get the medical care needed and after wandering in various hospitals he reported at my clinic in congestive heart failure. Previous record showed antero-apical wall MI with Pericardial effusion. Thorough workup for elaboration of all the injuries and complications was instituted and the patient was discharged in NYHA functional class I.

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“…However, the shear force that is applied to the coronary artery wall via rapid deceleration can cause intimal tearing, whereas the generation of thrombosis has typically been considered the pathogenesis of occlusion [6] [17]- [19]. Therefore, in cases where CAG indicates simple occlusion, it is very possible that undetected intimal tearing may have occurred [18] [19]. When such intimal tearing exists, balloon angioplasty alone may allow a thrombus to re-form at that site [16].…”

Section: Discussionmentioning

confidence: 99%

Ventricular Fibrillation Caused by Traumatic Coronary Artery Dissection

Ishikawa¹,

Morimura

Nagai³

et al. 2015

CRCM

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Coronary artery dissection due to blunt chest trauma (traumatic coronary artery dissection [TCAD]) may heal spontaneously, and some surgeons believe that conservative or elective treatments are sufficient, provided that there are no progressing ischemic symptoms. However, we report a patient who experienced sudden ventricular fibrillation (VF) during initial medical care for trauma injuries. The 32-year-old woman was riding in a passenger car when an accident occurred, and was subsequently transported to our emergency department. Twelve-lead electrocardiography revealed ST segment elevation in leads II, III, and aVF, although her vital signs remained stable. Therefore, we prioritized assessing the trauma at other sites, and VF suddenly occurred. Coronary angiography was performed with repeated defibrillation and chest compressions, which resulted in recovery of spontaneous circulation. Occlusion was observed in the right coronary artery, which we treated with balloon angioplasty. However, intravascular ultrasonography (IVUS) subsequently revealed coronary artery dissection, a stent was placed, and the patient successfully recovered. Therefore, IVUS may be useful for diagnosing TCAD, and swift intervention is needed if TCAD is detected.

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Coronary artery dissection after blunt chest trauma

Cited by 4 publications

References 4 publications

Analysis of Predictors of Myocardial Infarction in Trauma With Development of a Trauma Cardiac Risk Index

Analysis of Predictors of Myocardial Infarction in Trauma With Development of a Trauma Cardiac Risk Index

Acute Myocardial Infarction Due to Knife Injury – A Case Report

Ventricular Fibrillation Caused by Traumatic Coronary Artery Dissection

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