CASE REPORT
Coronary artery dissection following blunt chest trauma: a case report
B.M. Swinkels, G. Hoedemaker, R.H.J. Peters
Coronary artery dissection following blunt chest trauma is rare. We report the case of a 43-year-old woman who was admitted with a subacute inferior myocardial infarction due to dissection of the right coronary artery. Ten days earlier, she had sustained a minimal chest trauma. The literature is reviewed and management is discussed. (Neth Heart J
2005;13:190-2.)
Key words: coronary artery dissection, blunt chest trauma, acute coronary syndrome, myocardial infarction
oronary artery dissection following blunt chest C trauma is a rare cause ofischaemic heart disease.' Management has to be individualised, as the best treatment of these patients is not well established.2The purpose of this case report is to illustrate a successful medical approach. We present the case of a 43-yearold woman who was admitted with a subacute inferior myocardial infarction due to dissection of the right coronary artery, probably related to a fall with her sternum onto the tip of a door handle ten days earlier. Medical treatment resulted in complete recovery of the patient. Case report A 43-year-old woman with Parkinson's disease and no known cardiac risk factors except smoking was admitted to the coronary care unit of our hospital because of a ten-hour history of severe chest pain. Ten days earlier, she had had a painful fall in the bathroom when she fell with her sternum onto the tip of a door handle. B.M. Swinkels G. Hoodemaker R.H.J. Peters Department of Cardiology, Gooi-Noord Hospital, Laren
Correspondence to: B.M. Swinkels Department of Cardiology, Gooi-Noord Hospital, PO Box 900, 1250 CA Laren E-mail: [email protected]
190
Thereafter, she had experienced progressive exertional chest pain, culminating in resting chest pain on the day of admission. On presentation to the emergency room, she had been free of pain for one hour. On physical examination, she measured 1.80 m and weighed 70 kg. Her blood pressure was 115/80 mmHg and her heart rate was regular at a rate of 80 beats/min. The jugular venous pressure was normal. Cardiac auscultation revealed normal heart sounds without murmurs or rubs. The lungs were clear to auscultation. The electrocardiogram showed sinus rhythm with inverted T waves in leads II, III and aVF, and 1 mm ST-segment depression in leads V3 to V6. The chest X-ray showed normal cardiac size without sternum or rib fractures. Creatine kinase (CK) and CK-MB/CK ratio on presentation were increased (242 U/I and 7%, respectively, normal values
Coronary artery dissection following blunt chest trauma: a case report
B.M. Swinkels, G. Hoedemaker, R.H.J. Peters
Coronary artery dissection following blunt chest trauma is rare. We report the case of a 43-year-old woman who was admitted with a subacute inferior myocardial infarction due to dissection of the right coronary artery. Ten days earlier, she had sustained a minimal chest trauma. The literature is reviewed and management is discussed. (Neth Heart J
2005;13:190-2.)
Key words: coronary artery dissection, blunt chest trauma, acute coronary syndrome, myocardial infarction
oronary artery dissection following blunt chest C trauma is a rare cause ofischaemic heart disease.' Management has to be individualised, as the best treatment of these patients is not well established.2The purpose of this case report is to illustrate a successful medical approach. We present the case of a 43-yearold woman who was admitted with a subacute inferior myocardial infarction due to dissection of the right coronary artery, probably related to a fall with her sternum onto the tip of a door handle ten days earlier. Medical treatment resulted in complete recovery of the patient. Case report A 43-year-old woman with Parkinson's disease and no known cardiac risk factors except smoking was admitted to the coronary care unit of our hospital because of a ten-hour history of severe chest pain. Ten days earlier, she had had a painful fall in the bathroom when she fell with her sternum onto the tip of a door handle. B.M. Swinkels G. Hoodemaker R.H.J. Peters Department of Cardiology, Gooi-Noord Hospital, Laren
Correspondence to: B.M. Swinkels Department of Cardiology, Gooi-Noord Hospital, PO Box 900, 1250 CA Laren E-mail: [email protected]
190
Thereafter, she had experienced progressive exertional chest pain, culminating in resting chest pain on the day of admission. On presentation to the emergency room, she had been free of pain for one hour. On physical examination, she measured 1.80 m and weighed 70 kg. Her blood pressure was 115/80 mmHg and her heart rate was regular at a rate of 80 beats/min. The jugular venous pressure was normal. Cardiac auscultation revealed normal heart sounds without murmurs or rubs. The lungs were clear to auscultation. The electrocardiogram showed sinus rhythm with inverted T waves in leads II, III and aVF, and 1 mm ST-segment depression in leads V3 to V6. The chest X-ray showed normal cardiac size without sternum or rib fractures. Creatine kinase (CK) and CK-MB/CK ratio on presentation were increased (242 U/I and 7%, respectively, normal values
