Jiang Tao, Qian Cheng, Wei Gang, Cheng Ling, Zheng Wenwu, Chen Gong
Depatment of Cardiology, The Affiliated Hospital of Southwest Medical University, Luzhou, China.
Depatment of Infection Managrment, The Affiliated Hospital of Southwest Medical University, Luzhou, China.
Front Cardiovasc Med. 2023 Sep 5;10:1226129. doi: 10.3389/fcvm.2023.1226129. eCollection 2023.
Coronary artery dissection caused by trauma is a rare occurrence that can be life-threatening. Accordingly, its rapid identification and treatment are essential to improve patient outcomes. Here, we present a case of a patient who suffered multiple rib and femur fractures after falling from a height of eighteen meters and subsequently experienced persistent chest pain. After the initial diagnostic workup, the medical team diagnosed the patient's chest pain as rib fractures and failed to consider the potential of a cardiac injury as the underlying cause. No emphasis was placed on monitoring changes in myocardial enzymes and ECG, which could have indicated coronary artery dissection. The dissection was confirmed and treated with a stent only after the subsequent coronary angiography (CAG) and optical coherence tomography (OCT) examinations, gradually relieving the patient's chest pain. In this case report, we discuss the management of fractures complicated by traumatic coronary artery dissection and highlight the benefits of OCT in diagnosing and treating this condition. The case also emphasizes the importance of considering coronary artery injury in patients with chest pain due to trauma.
创伤性冠状动脉夹层是一种罕见但可能危及生命的情况。因此，快速识别和治疗对于改善患者预后至关重要。在此，我们报告一例患者，该患者从18米高处坠落，导致多处肋骨和股骨骨折，随后持续胸痛。经过初步诊断检查，医疗团队将患者的胸痛诊断为肋骨骨折，未考虑心脏损伤作为潜在病因的可能性。未重视监测心肌酶和心电图的变化，而这些变化可能提示冠状动脉夹层。仅在随后的冠状动脉造影（CAG）和光学相干断层扫描（OCT）检查后才确诊夹层并进行支架治疗，患者胸痛逐渐缓解。在本病例报告中，我们讨论了合并创伤性冠状动脉夹层骨折的处理，并强调了OCT在诊断和治疗这种情况中的益处。该病例还强调了对于因创伤导致胸痛的患者考虑冠状动脉损伤的重要性。
