Coronary dissection and myocardial infarction following blunt chest trauma

Myocardial infarction (MI) following blunt chest trauma is rarely diagnosed because the ensuing cardiac paon is commonly attributed to contused myocat dium or the traumatic injuries in the local chest wall. There are only scat tered reports on the coronary pathology associated with MI secondary to blu nt chest trauma. Because differemtiation of the pathology is difficult but important, we report here three cases of acute anterior MI secondary to cor onary dissection following blunt chest trauma. Coronary dissection was demo nstrated by coronary angiography. Two of the patients had intimal tears at the proximal left anterior descending artery (LAD) with normal flow, and th e other patient had nearly total occlusion of the LAD associated with filli ng defects probably caused by an intracoronary thrombus. All three patients received conservative treatment without major complications and remained f ree from angina or heart failure throughout a 5-year follow-up period. In o rder to exclude associated MI in cases of blunt chest trauma, electrocardio graphy is necessary, and coronary angiography may be indicated to demonstra te coronary arterial pathology. Dissection of the coronary artery with subs equent thrombus formation is one of the possible pathophysiologic mechanism s of MI following blunt chest trauma.