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Acute coronary artery occlusion secondary to blunt chest trauma
Insights
Blunt chest trauma can cause acute myocardial infarction (MI) by occluding the left anterior descending (LAD) artery. Prompt cardiac catheterization and arteriography are crucial for diagnosis and treatment in affected patients.
Area of Science:
- Cardiology
- Trauma Surgery
- Diagnostic Imaging
Background:
- Acute myocardial infarction (MI) is typically associated with atherosclerotic coronary artery disease.
- Blunt chest trauma is an uncommon cause of coronary artery occlusion.
Observation:
- Two patients presented with acute transmural MI due to proximal left anterior descending (LAD) artery occlusion following blunt chest trauma.
- Neither patient had prior ischemic heart disease; coronary arteriography revealed normal right and circumflex arteries.
Findings:
- One patient developed ventricular septal rupture and ventricular aneurysm with congestive heart failure.
- The other patient developed an acute ventricular aneurysm with congestive heart failure.
- Suggested mechanisms for LAD occlusion include intimal tear or subintimal hemorrhage with thrombosis.
Implications:
- Early diagnosis via ECG, cardiac catheterization, and coronary arteriography is vital for patients with blunt chest trauma and cardiac symptoms.
- Surgical intervention, including VSD closure, aneurysm resection, and LAD revascularization, can be successful.
- This case highlights a rare etiology of MI and emphasizes the importance of considering non-atherosclerotic causes in trauma patients.
Abstract:
Two patients suffered an acute transmural MI due to complete occlusion of the proximal LAD after blunt chest trauma. One developed a rupture of the ventricular septum with a ventricular aneurysm and the other an acute ventricular aneurysm, both accompanied by congestive heart failure. Neither had a history of ischemic heart disease; both had normal right and circumflex coronary arteries by arteriography. An intimal tear or subintimal hemorrhage with luminal thrombosis, or both, are the suggested mechanisms of coronary artery occlusion. Both patients were operated upon successfully. Patient 1 underwent closure of the VSD and resection of the ventricular aneurysm. The LAD had returned to normal and required no aortocoronary bypass graft. Patient 2 underwent arteriotomy of the LAD with Fogarty catheter embolectomy and aortocoronary bypass graft, combined with resection of the ventricular aneurysm. We recommend that patients who suffer blunt chest trauma and show ECG changes should undergo cardiac catheterization and coronary arteriography, followed by the pertinent treatment.