Abstract 17426: Acute Myocardial Infarction Due to Right Coronary Artery Occlusion Following Blunt Thoracic Trauma

Abstract

Blunt thoracic wall trauma can rarely lead to acute coronary artery injury and occlusion , and mostly involves the left anterior descending artery due to its vulnerable anterior anatomic positioning. Herein, we present a case of a young man who presented as a ST segment elevation MI (STEMI) with right coronary artery (RCA) occlusion after a blunt thoracic wall trauma. Clinical Vignette: A 37-year-old man with no previous medical history was brought to our ER with blunt chest wall trauma following a motor vehicle collision. Initial workup showed multiple fractures, a right pneumothorax and a pelvic hematoma. EKG performed for chest pain showed STEMI in the inferior and lateral leads. A 2D echocardiogram then showed inferolateral wall hypokinesis. Serial troponin I levels trended up sharply from 0.4 initially. After initiating intravenous heparin and cangrelor, the patient underwent emergent coronary angiography which revealed a rare, RCA occlusion with a thrombus. The patient then successfully underwent aspiration thrombectomy with restoration of TIMI grade III blood flow. Discussion: Hence, we presented a rare case of RCA occlusion resulting from blunt thoracic wall trauma. While musculoskeletal pain may mask the symptoms of myocardial hypoperfusion, a high index of suspicion for coronary artery thrombosis can lead to desirable outcomes in such patients.