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J Korean Soc Emerg Med > Volume 16(3); 2005 > Article
Journal of The Korean Society of Emergency Medicine 2005;16(3): 394-397.
Isolated Coronary Artery Dissection after Blunt Chest Trauma: A Case Report
Han Jin Cho, Han Sung Choi, Soo Joong Kim, Hoon Pyo Hong, Myung Chun Kim, Heung Sun Kang, Young Gwan Ko
1Department of Emergency Medicine, College of Medicine, KyungHee University, Seoul, Korea. edkmc@chol.com
2Division of Cardiology, Department of Medicine, College of Medicine, KyungHee University, Seoul, Korea.
ABSTRACT
Blunt chest trauma in intoxicated patients is very difficult to evaluate in the emergency medical center. Emergency physicians have difficulty figuring out the nature of the accident because the patients are frequently uncooperative. That is why we should always be cautious when evaluating intoxicated patients. Coronary artery dissection after blunt chest trauma is very rare, but delayed diagnosis can be lethal to the patient. We report a case of a27-year-old intoxicated male patient transferred to our emergency medical center after a motorcycle accident. After the primary survey, there were no severe external wounds, fractures or hemorrhages. We decided to monitor the patient in the observation unit until his mental status fully recovered. About two hours later, he complained of epigastric discomfort and dyspnea. His electrocardiogram showed ST segment elevation in leads I, aVL, V1- V4. Cardiac enzymes were also elevated. The coronary angiogram revealed a total occlusion of the proximal left anterior descending artery (LAD) and a dissecting flap was seen on intravascular ultrasonography. He recovered after successful stent insertion in the LAD lesion.
Key words: Blunt chest trauma, Coronary artery dissection, Acute myocardial infarction
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