ACUTE MYOCARDIAL-INFARCTION CAUSED BY DIS SECTION OF THE LEFT ANTERIOR DESCENDING ARTERY AFTER BLUNT CHEST TRAUMA, A CASE-REPORT

A 23 year old man, having experienced sudden retrosternal pain, radiat ing to both hemithoraces, with dyspnea at rest was admitted to another hospital. The physical examination of heart and lung was unremarkable , but the patient showed discrete signs of a respiratory infection. Be cause of the young age and the history of a respiratory infection, the differential diagnosis perimyocarditis was favored and an appropriate treatment was begun. Five days later the patient was transferred to o ur center for cardiac catheterization and further treatment. After adm ission the patient was reported to be hit by a football shortly before the onset of symptoms. The electrocardiogram and chemical values show ed the signs of myocardial damage with extensive myocardial necrosis. In the coronary arteriography a dissection of the proximal left anteri or descending artery of a length of about 2 cm was seen; in the levoca rdiogram anterior akinesis was verified. Because of the already comple ted myocardial infarction: the short distance of the lesion to the lef t main coronary artery, and the restored flow in the left anterior des cending, a noninvasive treatment was preferred. A control coronary art eriography five days later showed solely an irregularity of the vessel wall, the coronary dissection was not further demonstrable.