Right coronary artery dissection with inferior wall ST-segment elevation in a patient with thoracic blunt injury

Background: Blunt chest trauma, commonly caused by traffic accidents, is often associated with musculoskeletal injuries such as rib fractures and lung contusions. These symptoms may obscure more critical conditions like cardiac injury, resulting in delayed diagnosis and treatment. Although rare, blunt trauma can lead to coronary artery dissection and myocardial infarction. Case: We report a case of a 61-year-old female who presented to the emergency department with chest pain following a motor vehicle accident involving airbag deployment. Initial Computed Tomography (CT) scans identified multiple rib and cervical spine fractures, and chest pain was presumed to be musculoskeletal in origin. However, a delayed 12-lead electrocardiogram showed ST-segment elevation in the inferior leads, and subsequent coronary angiography confirmed a right coronary artery dissection. Hemodynamic instability and unsuccessful Percutaneous Coronary Intervention (PCI) were followed by emergency Veno-Arterial Extracorporeal Membrane Oxygenation (ECMO) placement. Despite aggressive management, her condition deteriorated, and she ultimately died after withdrawal of life-sustaining treatment. Conclusions: Blunt chest trauma can cause life-threatening cardiac injuries, including coronary artery dissection and myocardial infarction. In this case, electrocardiographic findings were key to identifying cardiac involvement, and coronary angiography confirmed right coronary artery dissection. Early use of 12-lead Electrocardiogram (ECG), cardiac biomarkers, and appropriate imaging is essential for timely diagnosis. For hemodynamically unstable patients, rapid intervention such as PCI, Coronary Artery Bypass Grafting (CABG), or ECMO should be considered. Increasing awareness of potential cardiac complications following blunt trauma is critical to improving survival outcomes.

Chest pain; Blunt cardiac injury; Blunt trauma; ST elevation MI; Emergency center

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