Abstract 19118: Coronary Artery Dissection After Blunt Chest Trauma
Coronary artery dissection is a rare complication of blunt chest trauma. We present an unusual case of coronary artery dissection and our approach to treatment. A 28 year-old previously healthy male presented initially to Urgent Care with chest pain for 5 days after being hit on the chest with a soccer ball. Electrocardiogram (ECG) was unremarkable and he was sent home but he returned 5 days later with worsening intermittent chest pain. Physical examination was normal. ECG showed ST elevation in leads V2-V5. Prompt coronary angiography showed a dissected and heavily thrombotic proximal to mid left anterior descending artery (LAD). AngioJet thrombectomy was performed followed by placement of three drug eluting stents: 4 x 28 mm, 4 x 16 mm and 4 x 38 mm. Transient no reflow happened which was treated via intracoronary adenosine. The final angiographic result was satisfactory but the very distal LAD remained occluded though with resolution of symptoms and ECG changes. The distal LAD recanalized on a follow up angiogram done for recurrent chest pain. The patient was placed on bivalirudin periprocedure and eptifibatide for 24 hours and was loaded with prasugrel. Troponin T peaked at 1.63 ng/mL. Echocardiogram showed ejection fraction of 35% with anteroapical hypokinesis with preserved thickness. The patient was discharged home after 3 days. Trauma-related myocardial infarction can be caused by coronary artery dissection and compression due to epicardial hematoma. We present a case of coronary artery dissection that could be easily missed in a young individual and should be suspected early on so that prompt intervention could be performed.
- © 2013 by American Heart Association, Inc.