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Acute myocardial infarction caused by coronary artery dissection following blunt chest trauma

Se Jung Yoon1, Hyuck Moon Kwon, Dong Soo Kim

  • 1Department of Internal Medicine, Yonsei University College of Medicine, 134 Shinchon-dong, Seodaemun-gu, Seoul 120-752, Korea.

Yonsei Medical Journal
|September 2, 2003
PubMed

Insights

Blunt chest trauma can rarely cause acute myocardial infarction (AMI). This case shows a traumatic coronary artery dissection healed with conservative management, highlighting the potential for good prognosis in select cases.

Area of Science:

  • Cardiology
  • Trauma Medicine
  • Interventional Cardiology

Background:

  • Chest trauma can precipitate diverse cardiac issues, including arrhythmias and myocardial rupture.
  • Acute myocardial infarction (AMI) is an infrequent but serious complication following chest trauma.

Observation:

  • A 66-year-old male sustained blunt chest trauma from a traffic accident, leading to AMI.
  • Coronary angiography revealed a dissection flap with calcification causing 50% ostial narrowing of the left anterior descending artery (LAD).
  • Intravascular ultrasonography (IVUS) confirmed eccentric calcified plaque with a dissection flap, showing a minimal luminal diameter (MLD) of 3.5 mm.

Findings:

  • Conservative management with aspirin and losartan was initiated due to the MLD and calcified flap, avoiding intervention.
  • Follow-up coronary angiography after 2 years demonstrated insignificant luminal narrowing at the LAD ostium with no evidence of dissection.
  • The patient experienced a favorable outcome with conservative treatment.

Implications:

  • Early coronary evaluation, including IVUS, is crucial for patients with persistent chest pain, elevated cardiac enzymes, and ECG abnormalities post-blunt chest trauma.
  • Selected cases of traumatic coronary artery dissections may heal effectively with conservative management, offering a good prognosis.

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