![]() ![]() However, critics could argue an ostially occluded LAD with Thrombolysis In Myocardial Infarction (TIMI) flow grade 0 in a 33-year-old should not be left alone and one wonders had the LAD been revascularized at presentation would the patient’s LV ejection fraction have remained depressed with subsequent development of LV thrombus. ( 2) made a thoughtful decision in not intervening, given the patient was asymptomatic, and followed the mantra to avoid intervention in coronary dissection if at all possible. This case raises a therapeutic dilemma in terms of revascularization for traumatic coronary dissection. Unfortunately, a repeat echocardiogram showed interval development of an LV apical thrombus and he was discharged on warfarin and aspirin therapy. Interestingly, the patient presented 6 days after discharge with pleuritic chest pain and a coronary computed tomography angiogram (CTA) demonstrated a patent LAD without evidence of dissection. He was discharged on medical therapy that included dual antiplatelet therapy. A follow-up echocardiogram demonstrated a mildly reduced left ventricular (LV) ejection fraction of 40% to 45% with anteroseptal wall motion abnormalities. He was monitored for 3 days in the hospital and remained stable. ( 2) made a measured and what some would say a brave decision not to intervene, given the patient was asymptomatic and there existed the potential to propagate the dissection retrograde into the left main and circumflex arteries. Surprisingly, the patient was completely chest pain free and hemodynamically stable. The patient was transferred for urgent coronary angiography that demonstrated a flush occluded LAD at the ostium with some features suggestive of coronary dissection. An electrocardiogram showed T-wave and ST changes in the anterior precordial leads with a mildly elevated troponin. The patient presents 7 months later with chest pain starting 24 h after an all-terrain vehicle accident. ( 2) describe a case of a 33-year-old man with previous traumatic injury to his descending thoracic aorta and right subclavian artery as a result of a motor vehicle accident. In the December issue of JACC: Case Reports, Rojas et al. The mechanism of injury is felt to be shear stress on the artery causing intimal tear ( 1). The left anterior descending artery (LAD) is the most commonly affected artery (76% of cases), presumably because of its anterior course and proximity to the chest wall. Traumatic coronary artery dissection (TCAD) is presumed to be a consequence of trauma due to a temporal relationship, although incidental spontaneous coronary artery dissection (SCAD) never can be completely ruled out. Its description in the literature is almost exclusively through case reports and a few autopsy series. Coronary artery dissection is a rare but potentially life-threatening result of blunt trauma injury. ![]()
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |