Abstract 18234: The Fast and the Furious, A Rare Case of RCA Dissection Following a Car Accident in a Male Patient

Abstract

Introduction: Coronary artery dissection is a rare, but potentially lethal, etiology of chest pain in the emergency department. Dissection is defined as a spontaneous, traumatic, or iatrogenic disruption of the tunica intima, causing blood to accumulate in a false lumen. Coronary artery dissection reportedly has a 0.1% incidence in the general population, occurring most commonly in the LAD, and less commonly in the RCA. Acute myocardial infarction (AMI) following blunt chest trauma has an age predominance of 82% being less than 45 years of age. With a low incidence and abnormal age presentation, an electrocardiogram must be included in the work-up of blunt chest trauma to assess for coronary artery dissection. Case: A 44-year-old male with a history of polysubstance abuse, obesity, and hypertension presented with left hip pain following a motor vehicle accident. The patient had been operating a small motorcycle when he struck a stationary vehicle. He was wearing a helmet but was ejected from the motorcycle, landing on his back. The patient eventually began to experience both right-sided chest pain as well as right-sided neck pain while in the. An electrocardiogram was performed that showed inferior ST-segment elevation with reciprocal ST-segment depression in the lateral leads. Troponins were 42ng/L, 1,465ng/L and 8,170ng/L. Cardiac catheterization revealed a spiral dissection of the RCA extending from the ostium to the mid-segment with TIMI 1 flow. The patient remained on medical management of aspirin, clopidogrel, and heparin and was monitored in intensive care for 48 hours prior to home discharge. Conclusion: Blunt force cardiac injury is an uncommon cause of chest pain and myocardial infarction, and rarer still is RCA dissection. This case highlights the distinct importance of electrocardiograms as a pivotal part of the trauma and chest pain diagnostic reasoning process.