( 2) made a thoughtful decision in not intervening, given the patient was asymptomatic, and followed the mantra to avoid intervention in coronary dissection if at all possible. This case raises a therapeutic dilemma in terms of revascularization for traumatic coronary dissection. Unfortunately, a repeat echocardiogram showed interval development of an LV apical thrombus and he was discharged on warfarin and aspirin therapy. Interestingly, the patient presented 6 days after discharge with pleuritic chest pain and a coronary computed tomography angiogram (CTA) demonstrated a patent LAD without evidence of dissection.
He was discharged on medical therapy that included dual antiplatelet therapy. A follow-up echocardiogram demonstrated a mildly reduced left ventricular (LV) ejection fraction of 40% to 45% with anteroseptal wall motion abnormalities. He was monitored for 3 days in the hospital and remained stable. ( 2) made a measured and what some would say a brave decision not to intervene, given the patient was asymptomatic and there existed the potential to propagate the dissection retrograde into the left main and circumflex arteries.
#Do one thing everyday that scares you free
Surprisingly, the patient was completely chest pain free and hemodynamically stable. The patient was transferred for urgent coronary angiography that demonstrated a flush occluded LAD at the ostium with some features suggestive of coronary dissection. An electrocardiogram showed T-wave and ST changes in the anterior precordial leads with a mildly elevated troponin. The patient presents 7 months later with chest pain starting 24 h after an all-terrain vehicle accident. ( 2) describe a case of a 33-year-old man with previous traumatic injury to his descending thoracic aorta and right subclavian artery as a result of a motor vehicle accident. In the December issue of JACC: Case Reports, Rojas et al. The mechanism of injury is felt to be shear stress on the artery causing intimal tear ( 1). The left anterior descending artery (LAD) is the most commonly affected artery (76% of cases), presumably because of its anterior course and proximity to the chest wall. Traumatic coronary artery dissection (TCAD) is presumed to be a consequence of trauma due to a temporal relationship, although incidental spontaneous coronary artery dissection (SCAD) never can be completely ruled out. Its description in the literature is almost exclusively through case reports and a few autopsy series. Coronary artery dissection is a rare but potentially life-threatening result of blunt trauma injury.
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