Traumatic Coronary Artery Dissection with Secondary Acute Myocardial Infarction after Blunt Thoracic Trauma

Abstract

We report the case of a 41-year-old male with traumatic coronary artery dissection after a high-speed motor vehicle collision. Computed tomography imaging revealed multiple intracranial subdural and subarachnoid bleedings, a skull base fracture and multiple bilateral rib fractures. There was no pericardial hemorrhage, haemothorax or pneumothorax. No intra-abdominal lesions were found. A 12-lead electrocardiogram on arrival showed an acute myocardial infarction. Emergency angiography showed complete dissection of the right coronary artery without reflow after placement of 6 coronary stents. The patient passed away the day after. In retrospective, the right coronary dissection was visible on the trauma CT-scan.

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

“…Isolated coronary artery dissection following blunt chest injury in the absence of other forms of cardiac injury is an uncommon and life-threatening complication [1]. To date, there have been very few reported cases of RCA dissection with an incidence of 12% compared to left anterior descending artery dissection, which is more commonly affected due to the proximity to the chest wall with an incidence of 76% [2].…”

“…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.…”

“…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).…”

Multivessel Traumatic Coronary Artery Dissection After a Motor Vehicle Accident With Successful Percutaneous Coronary Intervention

“…CT scan of the thorax is commonly obtained for triaging patients with blunt chest wall trauma. In one case report, a traumatic coronary dissection was seen on initial CT imaging when retrospectively reviewed ( 7 ). Furthermore, there is growing evidence that CT angiography is an effective method of visualizing coronary arteries and spontaneous coronary artery dissections ( 8 , 9 , 10 ).…”

Early Recanalization of a Traumatic Coronary Artery Dissection With Medical Therapy Alone

“…In a TCAD, the LAD is involved in ∼76% of the cases due to its anatomic location, followed by the right coronary artery and the left circumflex artery ( 1 ). The clinical presentation can vary significantly depending on the severity of trauma.…”