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Coronary dissection following chest trauma with systemic emboli
R D Goulah1, M R Rose, M Strober
1Department of Cardiology, St. Michael's Medical Center, Newark.
Insights
Blunt chest trauma can cause rare coronary artery dissection, leading to myocardial infarction and mural thrombus. This case highlights long-term risks of systemic emboli years after initial injury.
Area of Science:
- Cardiology
- Trauma Surgery
- Vascular Medicine
Background:
- Coronary artery dissection is an uncommon condition with diverse etiologies including trauma, iatrogenic causes, and spontaneous events.
- Dissection of the Left Anterior Descending (LAD) artery, though rare, can lead to significant cardiac complications.
- Systemic embolization is a potential, albeit infrequent, sequela of coronary artery pathology.
Observation:
- A young male patient presented with recurrent systemic emboli.
- The patient had a history of an asymptomatic anterior wall myocardial infarction three years prior.
- This infarction was associated with a dissection of the LAD and a mural thrombus, following blunt chest trauma.
Findings:
- The case demonstrates a delayed presentation of complications stemming from coronary artery dissection.
- Recurrent systemic emboli occurred years after the initial traumatic event and subsequent myocardial infarction.
- The underlying pathology involved LAD dissection and mural thrombus formation.
Implications:
- This case underscores the importance of long-term monitoring for patients with a history of coronary artery dissection, even after seemingly resolved events.
- It highlights the potential for delayed embolic complications following traumatic coronary artery dissection.
- Awareness of these delayed sequelae is crucial for clinicians managing patients with a history of chest trauma and cardiac injury.
Abstract:
Coronary artery dissection is a rare entity which occurs following blunt chest trauma, during coronary angiography and coronary bypass surgery, and spontaneously in the peripartum period. We report a young man who presented with recurrent systemic emboli following an asymptomatic anterior wall myocardial infarction associated with dissection of the LAD and mural thrombus three years earlier after sustaining blunt chest trauma.