Heart India

CASE REPORT
Year
: 2016  |  Volume : 4  |  Issue : 1  |  Page : 31--32

Coronary artery dissection following chest trauma


Manoj K Agarwala, Sundar Chidambaram, Naveen K Gummadi 
 Department of Cardiology, Apollo Hospital, Hyderabad, Telangana, India

Correspondence Address:
Sundar Chidambaram
Department of Cardiology, Apollo Hospital, Jubilee Hills, Hyderabad - 500 092, Telangana
India

Abstract

Chest trauma has a high rate of mortality. Coronary dissection causing myocardial infarction (MI) following blunt chest trauma is rare. We describe the case of an anterior MI following blunt chest trauma. A 39-year-old male was received in our hospital following a motorcycle accident. The patient was asymptomatic before the accident. The patient underwent craniotomy for evacuation of hematoma. He developed severe chest pain and an electrocardiogram (ECG) revealed anterior ST segment elevation following surgery. Acute coronary event was medically managed; subsequently, coronary angiogram was performed that showed dissection in the left anterior coronary artery, which was stented.



How to cite this article:
Agarwala MK, Chidambaram S, Gummadi NK. Coronary artery dissection following chest trauma.Heart India 2016;4:31-32


How to cite this URL:
Agarwala MK, Chidambaram S, Gummadi NK. Coronary artery dissection following chest trauma. Heart India [serial online] 2016 [cited 2019 Dec 14 ];4:31-32
Available from: http://www.heartindia.net/text.asp?2016/4/1/31/178121


Full Text

 Case Report



A 39-year-old male, who met with a road traffic accident, was received in our hospital. He was asymptomatic and without any comorbidities before the accident. He was diagnosed to have subdural hematoma and for which he underwent craniotomy. He had severe chest pain 6 h after the surgery and the electrocardiogram (ECG) showed anterior wall myocardial infarction (MI) and echocardiography showed regional wall motion abnormality in the left anterior descending artery (LAD) territory. Because the patient underwent surgery and contraindication for thrombolytics and antiplatelet, the patient was managed medically. Subsequently, 3 weeks later, the patient was taken up for coronary angiogram. Coronary angiogram revealed dissection in the proximal LAD that was stented with drug-eluting stent. The patient was discharged in a stable condition.

 Discussion



Chest trauma is known to cause cardiac contusion; however, acute MI is a rare complication of it. It can occur following blunt chest trauma, secondary to coronary artery dissection, spasm of the coronary artery, intimal tear, subintimal hemorrhage, aneurysm intraluminal thrombosis and vessel rupture and external compression by epicardial hematoma, and hemorrhage into a preexisting atheromatous plaque.[1]

The most common affected artery is the LAD due to its proximity to the chest wall. A relative weakness to the forces that accelerate and decelerate at the junction of the proximal and middle LAD could additionally explain the higher incidence of injuries to this vessel.[2] The second most commonly affected artery is the right coronary artery; it is vulnerable because it runs anteriorly toward the sternum during systole and is affected by rapid deceleration, resulting in disruption of its junction from the aortic root.[3] The left circumflex artery involvement is uncommon. Our patient had a dissection of the LAD.

Early identification remains a challenge. Diagnosis can be difficult because chest pain can be due to chest contusion or could be overshadowed by concomitant injuries.[4] Initial evaluation should be oriented to stabilization according to standard protocol. Our patient was managed medically as he underwent craniotomy. After initial medical stabilization the patient underwent coronary angiogram that showed dissection of the LAD [Figure 1]a and [Figure 1]b. Dissection was managed by putting a drug-eluting stent [Figure 2]a and [Figure 2]b. Following the intervention in the LAD after head trauma, concern regarding dual antiplatelet exists. The patient is under monitoring with dual antiplatelets. After one year single antiplatelet drug is to be advised. Diagnosis of coronary dissection following chest trauma requires clinical suspicion and systematic evaluation.{Figure 1}{Figure 2}

 Conclusion



Cheat trauma following road traffic accident is common. Coronary dissection following chest trauma in this setting is a challenging situation. This case is being reported for its challenges in the management of the coronary dissection.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Christensen MD, Nielsen PE, Sleight P. Prior blunt chest trauma may be a cause of single vessel coronary disease; hypothesis and review. Int J Cardiol 2006;108:1-5.
2Lobay KW, MacGougan CK. Traumatic coronary artery dissection: A case report and literature review. J Emerg Med 2012;43:e239-43.
3Kawahito K, Hasegawa T, Misawa Y, Fuse K. Right coronary artery dissection and acute infarction due to blunt trauma: Report of a case. Surg Today 1998:28;971-3.
4Regueiro A, Alvarez-Contreras L, Martín-Yuste V, Kasa G, Sabaté M. Right coronary artery dissection following blunt chest trauma. Eur Heart J Acute Cardiovasc Care 2012;1:50-2.