Keywords
Traumatic Coronary Dissection
Abstract
Case report: A 54-year old man with no prior medical history fell from a height of about 3 meters. He reported pain to the chest and fractures of both forearms fracture of the first rib with a pneumothorax and a large injury of the IV segment (III grade AAST).
The EKG showed an ST elevation on the anterolateral leads and an ST depression on the inferior leads; echocardiographic evaluation showed an akinetic mid-apical septum and apex and a severe impairment of the left ventricle
The coronarography revealed a dissection of the proximal Left Anterior Descending (LAD) coronary artery and of the Left Main Coronary Artery (LMCA). Two Drug-Eluting Stents (DES) were positioned. The following day echocardiographic examination showed a Left Ventricular Ejection Fraction (LVEF) of 40%.
Discussion: Coronary dissection following blunt chest trauma is a rare but potentially fatal event. The most affected vessel is the LAD coronary artery, probably for the more vulnerable anatomic position. It’s difficult to recognize and there are no guidelines that can help identify patients at risk, but its early diagnosis is essential to minimize the morbidity and mortality of this event. For the treatment every case needs to be discussed considering the associated injuries and their bleeding risk.
Conclusion: The implementation of trauma team protocols, availability of all the members of the trauma team and the possibility to perform all the diagnostic and therapeutic procedures H24 allows a more efficient triage and a reduction of the time that passes between patient arrival and the performance of life-saving procedures.
Citation
Ferrari A, Riva I, Valetti TM, Amer M, Soffia S, Nasi A, et al. Traumatic Coronary Dissection and Associated Hepatic Injury in a Polytrauma Patient - Case Report and Review of Literature. SM J Anesth. 2017; 3(2): 1012.