This Article Extract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Hazeleger, R. Articles by Landsaat, P. Search for Related Content PubMed PubMed Citation Articles by Hazeleger, R. Articles by Landsaat, P. Related Collections Catheter-based coronary interventions: stents Acute myocardial infarction Coronary circulation Mechanism of atherosclerosis/growth factors

(Circulation. 2001;103:1174.)
© 2001 American Heart Association, Inc.

Images in Cardiovascular Medicine

Coronary Dissection and Occlusion due to Sports Injury

Ronald Hazeleger, MD; Ron van der Wieken, MD; Ton Slagboom, MD; Peter Landsaat, MD

From Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands.

Correspondence to L.R. van der Wieken, MD, Klinische Cardiologie, Interventie Cardiologie, Onze Lieve Vrouwe Gasthuis, Postbus 95500, 1^e Oosterparkstraat 279, Amsterdam, 1090 HM Netherlands. E-mail L.R.vanderwieken{at}olvg.nl

A 29-year-old man presented with heavy chest pain of 1 hour duration. Two months earlier, after a violent body check while playing American football, he had the same discomfort, albeit to a lesser degree, on slight exertion. Previously, he had been healthy, with no risk factors for coronary artery disease.

Physical examination was unremarkable. The ECG showed an extensive acute anterior infarction. Nitroglycerin, tirofiban, and aspirin were administered intravenously, and an emergency coronary angiography was performed from the right radial artery (Figure 1). The left anterior descending artery was occluded proximally, and a large obtuse marginal branch showed a dissection-like intraluminal filling defect without obstruction. All other coronary arteries appeared normal. The occlusion was crossed with a guidewire, dilated, and stented (JOMED, 16x3.5), with a good initial result. The dissection flap was left as it was. Pain and ST-segment elevation subsided quickly, and a moderate elevation of cardiospecific enzymes was found. Tirofiban was continued for 24 hours.

View larger version (196K): [in this window] [in a new window]   Figure 1. Angiography of left coronary artery on admission. Thick arrow points to occlusion of left anterior descending artery; slender arrow indicates a dissection flap in obtuse marginal branch of circumflex artery.

Control coronary angiography 5 days later (Figure 2) showed a widely patent stent and a normal angiographic appearance of the obtuse marginal branch. After 30 days, the patient had no anginal complaints and felt well.

View larger version (188K): [in this window] [in a new window]   Figure 2. Angiography 5 days after admission. Stent in left anterior descending artery is widely patent. Dissection flap in obtuse marginal branch is no longer visible.

Footnotes

The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.

Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke’s Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.

This Article Extract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Hazeleger, R. Articles by Landsaat, P. Search for Related Content PubMed PubMed Citation Articles by Hazeleger, R. Articles by Landsaat, P. Related Collections Catheter-based coronary interventions: stents Acute myocardial infarction Coronary circulation Mechanism of atherosclerosis/growth factors