How to break a mended heart

Thoracic trauma poses a risk of injury to the thoracic organs and great vessels, including the coronaries. We present an interesting case of occult, life-threatening coronary bypass graft injury resulting from thoracic trauma. In this case, the diagnosis and management were contingent on understanding the nature of the bypass graft, which was not apparent at the time of presentation in extremis. Ultimate hemostasis required cardiac catheterization and placement of an exclusionary stent. Though there are several case reports describing native coronary injury resulting from thoracic injury, we found a single case of thoracic trauma-associated coronary bypass graft injury, which was managed medically. The case we present here demonstrates that though coronary bypass graft injuries are life-threatening and rare, they can be managed with techniques utilizing cardiac catheterization if accompanied by a high index of suspicion. This case further demonstrates that additional cardiac studies for patients who present with high-impact thoracic injuries and a history of coronary bypass grafts may facilitate expeditious diagnosis and effective management