Abstract:
We describe the case of an inferior MI following blunt chest trauma. A 46-year-old male without any relevant medical history was transported to the emergency room after a car accident. First diagnostic tests showed multiple rib fractures with bilateral pneumothorax (PNX) and pulmonary contusion. Cardiac contusion was suspected due to a mild increase of myocardial cytonecrosis markers without alteration of electrocardiogram (ECG) and echocardiogram. So, the patient was discharged two weeks later when PNX was resolved. After few days he was readmitted to the hospital complaining chest pain and palpitations; ECG revealed inferior q waves. Echocardiography and cardiac MRI confirmed a recent inferior MI. He was submitted to coronary angiography which showed a dissection of the right coronary artery in the proximal segment. Interestingly, angiography showed an anomalous high origin of the vessel above the sinotubular junction. A drug-eluting stent was implanted with a good final angiographic result. The patient was discharged after two days. One month later he was asymptomatic. Cardiac contusion is not uncommon; however acute MI is a rare complication of blunt chest trauma. Careful clinical suspicion can lead to optimal medical care. However, best treatment of these uncommon case remain debated.
Keywords:
Myocardial infarction, coronary artery dissection, blunt chest trauma