Abstract 11787: Traumatic Acute Myocardial Infarction Following Blunt Chest Trauma

Coronary artery dissection is a rare complication following blunt chest trauma, accounting for <2% of blunt cardiac injuries. The diagnosis is frequently missed likely due to intervening concomitant injuries or sudden death. We report a case of motorcycle collision causing multiple injuries including blunt chest trauma associated with new inferior injury pattern on ECG in 43-year-old previously healthy man. Initially the patient was hypertensive and tachycardic. Electrocardiogram showed inferior ST elevation, bedside echocardiogram revealed distal apical and inferoapical hypokinesis with normal ejection fraction without pericardial effusion. Given the mechanism of injury, CT angiography and TEE first excluded the initial working diagnosis of aortic dissection. Urgent angiography showed a distal dissection of a wrap around LAD. Attempted revascularization was unsuccessful due to the inability to find the true lumen. Concomitant multiple fractures, lung contusion and a small mediastinal hematoma prevented anticoagulation therapy and conservative management ensued. Follow-up echocardiogram confirmed a sustained infarction with distal anterior and apical akinesis but preserved ejection fraction. No arrhythmia or recurrent ischemia noted during hospital admission, however he was chosen to manage conservatively for his wrist fracture due to recent infarction. This case report underscores need for a high index of suspicion for cardiac injury and the need to maintain a broad differential following chest trauma. Additionally, presence of an injury pattern should prompt confirmatory angiography to differentiate coronary injury from cardiac contusion as they have different long-term outcome.