Post-traumatic left anterior descending artery dissection
Lexis T Laubach1, Glenn A Burket1, Robert D Barraco2
1Department of Emergency and Hospital Medicine, United States of America.
The American Journal of Emergency Medicine
|March 7, 2020
Summary
Trauma patients, especially those with thoracic injuries, risk missed cardiac injury. Emergency physicians should use EKGs to screen for myocardial infarction (MI) in trauma evaluations.
Area of Science:
- Emergency Medicine
- Cardiology
- Trauma Surgery
Background:
- Thoracic trauma poses a risk for occult cardiac injury.
- Patients with severe trauma may have distracting injuries or be unable to communicate symptoms, increasing the risk of missed diagnoses.
Observation:
- A 36-year-old male sustained severe injuries in a high-speed motor vehicle crash.
- Initial CT scans revealed hemopneumothorax and orthopedic injuries, leading to ICU admission.
- Telemetry monitoring showed ST elevations, prompting an electrocardiogram (EKG).
Findings:
- The EKG revealed an acute ST-elevation myocardial infarction (STEMI).
- Cardiac catheterization identified a left anterior descending (LAD) coronary artery dissection.
- A stent was successfully placed, treating the LAD dissection.
Implications:
- Emergency physicians must consider cardiac injury, including myocardial infarction (MI), in trauma patients.
- EKG is a critical tool in the emergency department evaluation of trauma patients, particularly those with thoracic trauma.
- Prompt recognition and management of cardiac injury in trauma can prevent adverse outcomes.
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