Korean J Thorac Cardiovasc Surg.  2015 Aug;48(4):281-284. 10.5090/kjtcs.2015.48.4.281.

Traumatic Coronary Artery Dissection in a Young Woman after a Kick to Her Back

• Ipek E
• Ermis E
• Demirelli
• Yildirim E
• Yolcu M
• Sahin BD

• KMID: 2382273
• DOI: http://doi.org/10.5090/kjtcs.2015.48.4.281

Abstract

We present the case of a 38-year-old woman admitted to our outpatient clinic with accelerating back pain and fatigue following a kick to her back by her husband. Upon arrival, we detected ST segment elevation in the D1, aVL, and V2 leads and accelerated idioventricular rhythm. She had pallor and hypotension consistent with cardiogenic shock. We immediately performed coronary angiography and found a long dissection starting from the mid-left main coronary artery and progressing into the mid-left anterior descending (LAD) and circumflex arteries. She was then transferred to the operating room for surgery. A saphenous vein was grafted to the distal LAD. Since the patient was hypotensive under noradrenaline and dopamine infusions, she was transferred to the cardiovascular surgery intensive care unit on an extracorporeal membrane oxygenator and intra-aortic balloon pump. During follow-up, her blood pressure remained low, at approximately 60/40 mmHg, despite aggressive inotropic and mechanical support. On the second postoperative day, asystole and cardiovascular arrest quickly developed, and despite aggressive cardiopulmonary resuscitation, she died.

Keyword

Coronary; Back; Dissection; Kick; Traumatic

MeSH Terms

Accelerated Idioventricular Rhythm
Adult
Ambulatory Care Facilities
Arteries
Back Pain
Blood Pressure
Cardiopulmonary Resuscitation
Coronary Angiography
Coronary Vessels*
Dopamine
Fatigue
Female
Follow-Up Studies
Heart Arrest
Humans
Hypotension
Intensive Care Units
Norepinephrine
Operating Rooms
Oxygenators, Membrane
Pallor
Saphenous Vein
Shock, Cardiogenic
Spouses
Transplants
Dopamine
Norepinephrine