Coronary Dissection and Occlusion due to Sports Injury
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, 16×3.5), 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.
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.
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.
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