Cardiac Electrophysiology Research Center, Rajaie Cardiovascular, Medical and Research Centre, Tehran University of Medical Sciences, Tehran, Iran.
Rajaie Cardiovascular, Medical and Research Centre, Tehran University of Medical Sciences, Tehran, Iran.
Arch Iran Med. 2014 Jan;17(1):86-90.
Coronary artery dissection is a well-known albeit unusual complication of blunt chest trauma. It is also an uncommon cause of myocardial infarction. Only a few such cases have been reported, probably due to the high rate of sudden death. We report a case of left anterior descending (LAD) coronary artery dissection in a healthy 38-year-old female caused by blunt chest trauma. The patient was referred to our hospital with a complaint of chest pain. Electrocardiography showed T-wave inversion, echocardiography a revealed circumferential pericardial effusion, and the coronary angiogram demonstrated a thrombotic dissection of the LAD. Troponin I was the only biomarker with elevated level. CT coronary angiography was performed using the subtotal occlusion of the LAD and illustrated a relatively good LAD run-off, and thallium scintigraphy displayed viable myocardium in this territory. Despite the total occlusion of the LAD in our case, myocardial injury was not significant due to the relatively good LAD run-off. She underwent coronary artery bypass graft surgery with an excellent result.
冠状动脉夹层是钝性胸部创伤的一种众所周知但不常见的并发症。它也是心肌梗死的一个不常见原因。由于死亡率较高，仅有少数此类病例报告。我们报告了一例由钝性胸部创伤引起的健康 38 岁女性左前降支（LAD）冠状动脉夹层。患者因胸痛就诊于我院。心电图显示 T 波倒置，超声心动图显示心包环形积液，冠状动脉造影显示 LAD 血栓性夹层。肌钙蛋白 I 是唯一升高的生物标志物。采用 LAD 次全闭塞进行 CT 冠状动脉造影，显示 LAD 流出道相对较好，锝闪烁扫描显示该区域有存活心肌。尽管在我们的病例中 LAD 完全闭塞，但由于 LAD 流出道相对较好，心肌损伤并不明显。她接受了冠状动脉旁路移植术，效果极佳。
