RIGHT CORONARY-ARTERY OCCLUSION SECONDARY TO BLUNT TRAUMA

The heart lies in a vulnerable position when the chest is subjected to direct blunt trauma. Acute occlusion of a coronary artery from blunt chest trauma is rare, with occlusion of the right coronary artery at i ts origin recorded only twice in the English literature. A young male unrestrained driver sustained an acute deceleration injury with signif icant chest trauma when he crashed, crushing the steering wheel agains t his chest. Creatine phosphokinase isoenzymes were initially 2% of th e total and 8% 12 h later. There were marked electrocardiographic chan ges, and an echocardiogram revealed abnormal left ventricular systolic function with an akinetic inferior-posterior wall and right ventricul ar enlargement. A wide mediastinum and mechanism of injury led to the performance of aortography which failed to disclose a right coronary v essel. Subsequently coronary angiography confirmed acute occlusion of the proximal right coronary artery. Because of other associated injuri es, nonoperative medical management was successfully utilized.