Missed Coronary Artery Dissection Post-Blunt Chest Trauma.
Cureus 2023;
15:e47630. [PMID:
38022221 PMCID:
PMC10680047 DOI:
10.7759/cureus.47630]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2023] [Indexed: 12/01/2023] Open
Abstract
Cardiac contusion is rarely diagnosed in patients with blunt chest trauma in the emergency department, especially if patients are asymptomatic. We present a case of a 43-year-old man whose diagnosis of left anterior descending artery (LAD) dissection after blunt chest trauma was delayed. The patient presented to the emergency department of a remote district hospital after a motorcycle accident, asymptomatic with a mildly reduced level of consciousness due to a very small subdural hemorrhage. Ten days later, when he developed a syncopal attack due to a massive pulmonary embolism (PE), his first performed electrocardiogram (ECG) showed sinus rhythm with QS waves and slight ST elevation in leads V2-V6. The subsequent coronary angiography showed left anterior descending artery dissection, and the diagnosis was nicely depicted with optical coherence tomography (OCT). A drug-eluting stent was implanted with a good angiographic result. This case highlights the significance of early recognition of traumatic coronary dissection, which should be excluded even in asymptomatic patients with a plain ECG acquisition, for the appropriate management and prevention of unfavorable outcomes.
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