Acute Fatal Coronary Artery Dissection Following Exercise‐related Blunt Chest Trauma

Abstract

Coronary artery injury such as acute coronary dissection is an uncommon and potentially life-threatening complication after blunt chest trauma. The authors report an unusual autopsy case of a 43-year-old healthy man who suddenly collapsed after receiving a punch to the chest during the practice of kung fu. The occurrence of the punch was supported by the presence of one recent contusion on the left lateral chest area at the external examination and by areas of hemorrhage next to the left lateral intercostal spaces at the internal examination. The histological examination revealed the presence of an acute dissection of the proximal segment of the left anterior descending coronary artery. Only few cases of coronary artery dissection have been reported due to trauma during sports activities such as rugby and soccer games, but never during the practice of martial arts, sports usually considered as safe and responsible for only minor trauma.

Fatal left coronary artery dissection due to blunt chest trauma: A case report and literature review

“…[1][2][3] The most frequent signs associated with the dissection are dyspnoea, chest pain and ST elevation or depression on the electrocardiogram. [4][5][6][7][8][9][10][11][12][13][14][15][16] More importantly, autopsy did not allow this coronary dissection to be diagnosed. Gross examination showed a non-specific haemorrhagic tumefaction of the left anterior descending coronary artery.…”

“…The three main causes were traffic accident (55%; 6/11), physical aggression (27%; 3/11) and sporting accident (18%; 2/11). 4–13 The traffic accident included two vehicles (a motorcycle and a truck) that hit a tree, 5,11 and four head-on collisions (a pedestrian hit by a motorcycle, a car and a bike both hit by a truck, and a car hitting another car). 10,12,13 The aggressive behaviours involved a woman assaulted by her son who repeatedly stamped on her chest, 7 a fight between neighbours 8 and a woman who was kicked in the back by her husband.…”

“…10,12,13 The aggressive behaviours involved a woman assaulted by her son who repeatedly stamped on her chest, 7 a fight between neighbours 8 and a woman who was kicked in the back by her husband. 9 The two sporting injuries were a punch in the chest during martial arts training 4 and a fall during waterskiing (Table 1). 6 Two coronary dissections were detected by coronarography before the patients’ death.…”

“…1–3 Most cases involve male subjects aged <60 years after a traffic accident, physical aggression or a trauma during sporting activities. 4–16 Here, we report on an autopsy of a 58-year-old woman, who collapsed and died due to an acute coronary artery dissection 14 hours after blunt chest trauma in a car accident.…”

Fatal right coronary artery rupture following blunt chest trauma: detection by postmortem selective coronary angiography

“…The mechanism of traumatic coronary artery dissection is hypothesized to be shearing stress during a traumatic episode, which causes intimal tear of the vulnerable part and subsequently initiates the process of thrombus formation. Some reports have suggested that this shearing stress may occur during intense exercise without BCT, which might explain spontaneous coronary artery dissection in healthy individuals [19,20]. However, distinguishing spontaneous dissection from traumatic dissection is difficult, as no specific pathological differences exist between them [20].…”