Death from undetected acute myocardial infarction secondary to coronary artery dissection after blunt thoracic trauma

Puanglumyai, Supot; Thamtakerngkit, Somboon; Lekawanvijit, Suree

doi:10.1016/j.carpath.2015.09.004

Cited by 8 publications

(10 citation statements)

References 12 publications

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“…Histological signs of myocardial infarction, such as cardiomyocytes necrosis, were present in only three (33%) cases. 6,10,11 In conclusion, post-traumatic coronary dissection is a rare and potentially underdiagnosed complication of blunt chest trauma. Forensic pathologists should be aware of this rare cause of death.…”

Section: Discussionmentioning

confidence: 95%

“…[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.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2019

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Blunt chest traumas can cause cardiac injuries and contusions. However, post-traumatic coronary artery dissections are quite uncommon. Here, we report the case of a 58-year-old woman who died suddenly 14 hours after a car accident. The macroscopic anomalies observed during the autopsy could not explain the death. However, microscopic examination revealed an acute left anterior descending coronary dissection, with a cleavage of the external layers of the media. The infiltration of polymorphonuclear neutrophils in the adventitia was a sign of the pre-mortem occurrence of this lesion and was compatible with the chronology of the accident. It was the only pathological finding that could explain the death, which was probably caused by a cardiac rhythm disorder triggered by acute ischaemia. We did not observe specific histological signs of cardiac necrosis, and we observed no significant atheroma, vasculitis or dysplasia in the left anterior descending coronary artery. We concluded that the dissection was secondary to the blunt chest trauma. Eleven case reports of lethal post-traumatic coronary dissection have been reported in the literature. Most of them involved male subjects aged <60 years old following a traffic accident, and were localised to the left coronary artery or one of its branches. Histological specific signs of myocardial ischaemia were present in only 33% of the cases. In this case, only microscopic examination could identify the dissection. This pathology may be underdiagnosed, and it highlights the necessity to undertake rigorous examination of the heart and coronary arteries following blunt chest trauma.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

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

et al. 2019

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“…The mechanism leading to a coronary dissection after blunt chest trauma is most likely a shearing force that produces a small intimal tear, thereby enabling blood to enter the vascular wall and form a blood-filled space. 3 In consideration of information reported by the patient, there probably was no dissection, and the coronary lesion was self-limiting.…”

Section: A B a Bmentioning

confidence: 97%

Left Internal Thoracic Artery Graft to Left Anterior Descending Coronary Artery after Blunt-Chest-Trauma Myocardial Infarction: 14-Year Outcome

Évora¹,

Romano²,

Souza³

et al. 2017

Texas Heart Institute Journal

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“…Traumatic chest pain can mask angina and mislead physician from early diagnosis. The lack of recognition of this complication is associated with delayed treatment and potentially adverse consequences like heart failure and death .…”

Section: Introductionmentioning

confidence: 99%

Acute myocardial infarction secondary to blunt chest trauma in motorcycle accident: A rare combination where percutaneous coronary intervention and intravascular imaging optimization are needed

Boi

Sanna

Rossi

et al. 2018

Cathet Cardio Intervent

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Blunt chest trauma is a common occurrence in vehicle accident. Cardiac injuries following nonpenetrating thoracic trauma have been reported. ST-elevation myocardial infarction (STEMI) due to coronary artery involvement is a rare but extremely serious condition for the high risk of undetected diagnosis. Blunt thoracic trauma may obscure typical chest pain associated with cardiac ischemia especially in patients with high tolerance of pain or secondary administration of analgesic drugs. We report two consecutive cases of young adults admitted to our emergency department after motorcycle accident and concomitant anterior STEMI due to occlusion of left anterior descending artery. In both cases primary percutaneous coronary intervention with a second generation drug eluting stent implantation was successfully performed. Imaging with intravascular ultrasound and optical coherence tomography showed the mechanisms of coronary occlusion, allowing an optimal stent implantation and avoiding procedural complications in this complex setting.

show abstract

Death from undetected acute myocardial infarction secondary to coronary artery dissection after blunt thoracic trauma

Cited by 8 publications

References 12 publications

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

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

Left Internal Thoracic Artery Graft to Left Anterior Descending Coronary Artery after Blunt-Chest-Trauma Myocardial Infarction: 14-Year Outcome

Acute myocardial infarction secondary to blunt chest trauma in motorcycle accident: A rare combination where percutaneous coronary intervention and intravascular imaging optimization are needed

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