[Coronary dissection and non-penetrating chest trauma]

Myocardial Infarction Due to Coronary Artery Injury following High Force Blunt Trauma to the Upper Chest: A Case Illustrating the Prehospital, Hospital and Autopsy Findings

Myocardial infarction (MI) is a rare complication of blunt chest trauma (BCT). We describe an extensive antero-lateral MI due to thrombosis of the left main stem coronary artery following a blow to the lower face and upper anterior chest during an industrial accident in a 52-year-old male. The patient presented with acute left ventricular failure. Our case highlights MI as an important differential in a BCT patient presenting with hypoxia where lung pathology has been excluded. We aim to highlight the importance of cardiac assessment in trauma scenarios particularly where patients are unable to report symptoms. Our patient sadly did not survive his injuries. This case describes MI following BCT from the initial prehospital presentation through to postmortem findings and adds to the limited literature on the pathological mechanisms underpinning this rare complication.

Traumatic Coronary Dissection: Case Presentation and Literature Review

In posttraumatic coronary dissection, a small intimal tear occurs due to the sudden compression of the thoracic wall during the chest trauma, this being sometimes fatal. We present the case of a 56-year-old truck driver with chest trauma after a car crash. The 12-lead ECG showed signs suggestive of an acute anterior myocardial infarction, and the coronary angiography confirmed an arterial dissection of the left anterior descending coronary artery. A stent was inserted the same day, and the patient was treated accordingly. He survived for a total of three days. The autopsy and histological examination confirmed the MI and the coronary dissection. The chest trauma was linked to the patient’s death. The literature review reveals 46 cases in which the most frequent cause of chest trauma was a car or motorcycle accident; also, young male subjects were more frequently involved. Stent placement was the main course of treatment, and a delay in the onset of symptoms was also frequent.

[Extended coronary dissection caused by severe polytrauma with contusio cordis : Venoarterial ECMO-assisted percutaneous coronary intervention]

Treatment of a patient with acute cardiac failure due to a contusio cordis after polytrauma by an interdisciplinary team is reported. Shortly after admission to our shock room, the patient developed cardiogenic shock caused by an extended coronary dissection. After interim cardiopulmonary resuscitation, the patient was stabilized by venoarterial extracorporeal membrane oxygenation (ECMO) and subsequent complex coronary artery intervention in the heart catheter laboratory. Despite the increased left ventricular function which enabled partial weaning from the ECMO, the patient died of multiple organ failure 10 days after admission.

[Coronary artery dissection complicated by myocardial infarction in a head trauma patient]

Acute myocardial infarction, following coronary artery dissection, is a rare, but potentially fatal, syndrome after blunt chest trauma. The treatment is more complicated when intracerebral lesions are present, because of the need of anticoagulation. We report the case of a 37-year-old male patient, suffering from a polytraumatism with intracranial petechial haemorrhages who have a left coronary artery dissection with acute myocardial infarction.