Pastapur Aishwarya E, Bitar Abbas, Wanamaker Brett L
Department of Internal Medicine, University of Michigan, Ann Arbor, USA.
Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI 48109, USA.
Eur Heart J Case Rep. 2024 Feb 5;8(2):ytae056. doi: 10.1093/ehjcr/ytae056. eCollection 2024 Feb.
Coronary injury after blunt chest trauma is rare. This case illustrates the importance of evaluating for coronary injury after any episode of blunt chest wall trauma.
We review the case of a 27-year-old male who presented with acutely decompensated heart failure several months after a motor vehicle accident with chest wall impact from the steering wheel. Coronary angiography demonstrated an occluded left anterior descending artery, and he was found to have a severe ischaemic cardiomyopathy. After multiple hospital and intensive care unit admissions due to multi-organ dysfunction and debility, he was unable to tolerate any guideline-directed medical therapy. He was unable to be listed for heart transplantation due to his co-morbidities, multi-system sequelae of his heart failure, deconditioning, and recent substance use. He was ultimately discharged home with hospice.
Coronary or other cardiac injuries should be considered in the evaluation of all patients after blunt chest wall trauma, regardless of prior risk factors for ischaemia.
钝性胸部创伤后冠状动脉损伤较为罕见。本病例说明了在任何钝性胸壁创伤事件后评估冠状动脉损伤的重要性。
我们回顾了一名27岁男性的病例,该患者在机动车事故中胸部受到方向盘撞击数月后出现急性失代偿性心力衰竭。冠状动脉造影显示左前降支动脉闭塞,他被诊断为严重缺血性心肌病。由于多器官功能障碍和虚弱,他多次入住医院和重症监护病房,无法耐受任何指南指导的药物治疗。由于他的合并症、心力衰竭的多系统后遗症、身体机能下降以及近期使用药物,他无法被列入心脏移植名单。他最终在家中接受临终关怀出院。
在评估所有钝性胸壁创伤后的患者时,无论其既往有无缺血风险因素,均应考虑冠状动脉或其他心脏损伤。