Coronary artery dissection and acute myocardial infarction following blunt chest trauma

Blunt chest trauma might lead to cardiac injury ranging from simple arrhythmias to lethal conditions such as cardiac rupture. Acute myocardial infarction (AMI) may be induced by blunt chest trauma [1-3]. We experienced a case of coronary artery dissection with subsequent myocardial infarction from blunt chest trauma. We will give an overview of relevant literature regarding this topic.Parmley reported on 546 autopsy cases of blunt heart injury, and there were nine cases of coronary artery rupture and one case of intimal laceration [4]. None of the cases, however, showed signs of coronary artery occlusion. AMI as a result of coronary artery dissection has been considered rare [3], however coronary artery dissection from blunt trauma has been more frequently described recently [5-15]. This might indicate that this condition previously has been underdiagnosed or is increasing in incidence. The left anterior descending coronary artery (LAD) is the vessel most often affected, and road traffic accidents are the usual cause of traumatic myocardial infarction [3,16]. This susceptibility is attributable to the LAD's anatomic relation to the anterior chest wall allowing both direct trauma and deceleration as possible mechanisms of trauma [16]. In our case the patient suffered blunt chest trauma as his car collided with a moose. He experienced dissection of the middle part of the LAD (Figure 1). Both coronary artery dissection, intimal tear, plaque rupture or epicardial hematoma might lead to AMI after blunt trauma. However, in 12 published cases of traumatic AMI the coronary angiograms were completely normal [3]. Spasm or lysis of a thrombus might explain AMI in these cases. It should be noted that AMI also has been reported after mild trauma [13,17,18].In traumatic AMI, the diagnosis might be masked by chest pain originating from other thoracic injuries. ECG may be normal [18], but usually demonstrates abnormalities [15,16,19]. Our patient presented with right bundle branch