Delayed Presentation of Post-traumatic Coronary Artery Dissection Resulting in Acute Myocardial Infarction and Severe...

This case report describes a 32-year-old male patient who, two months after sustaining blunt chest trauma in a motor vehicle accident, presented with acute myocardial infarction (MI). Upon initial trauma evaluation abroad, it was reported that he had an unremarkable electrocardiogram (ECG) and chest CT and had remained asymptomatic. Two months later, he developed exertional chest pain and shortness of breath, prompting emergent reevaluation. The ECG demonstrated anterolateral ST-segment elevations, and cardiac troponins were markedly elevated (30-40 ng/L). Coronary angiography confirmed a dissection of the proximal left anterior descending (LAD) artery. The patient underwent successful angioplasty with stent placement. Despite successful revascularization, he developed severe heart failure with reduced ejection fraction (HFrEF), requiring guideline-directed medical therapy (GDMT), which showed improved ejection fraction (EF) from 27% to 30%-35% on follow-up. This case represents a delayed presentation of post-traumatic coronary artery dissection, given the temporal association with prior blunt chest trauma, absence of traditional atherosclerotic risk factors, and angiographic findings. It underscores the importance of maintaining high clinical suspicion for coronary injury in patients with a history of chest trauma, even after an initially normal evaluation.