Efficiently proceeding from a screening evaluation to a diagnostic evaluation allowed for rapid detection and treatment of the coronary dissection. Many types of cardiac injuries have been described after blunt chest trauma. Arrhythmia, cardiac contusion, and acute myocardial infarction
are among the more common injuries . Older patients can have ischemia induced by hemorrhagic shock superimposed on underlying cardiac disease, rather than from direct cardiac injury. Less commonly encountered are coronary artery laceration, thrombosis, or intimal dissection . Clinically the injuries can by asymptomatic, or may cause angina, hemodynamic instability, or commotio cordis, resulting in sudden death. Selleckchem PF-6463922 Coronary Artery Dissection Coronary artery dissections are most common in the left anterior descending artery (76%), right coronary artery (12%) and the circumflex (6%) . Very few cases have been reported from blunt trauma such as waterskiing , contact sports such as
BIBW2992 price basketball  and football , and high-speed impact such as motorcycle[7, 8], or motor vehicle collisions [9–12]. Dissection of the left main coronary artery is among the most rare sequela of blunt chest trauma. One trauma-related left main coronary dissection was reported see more 3 days after a head-on motor vehicle collision at only 15 mph . Cases through that have been reported in the literature are listed in table 2. Table 2 Review of reported coronary artery dissections, treatment strategies, and outcomes Author/Journal Patient age/sex Mechanism Injury Treatment Outcome Redondo, et al  Am J Emerg
Surg, 2009 45 yo F Motor vehicle collision LMCA-focal stenotic dissection; RCA dissection Angioplasty and heparin Death secondary to intra-abdominal hemorrhage Goyal, et al.  Heart, 2009 47 yo M Motor vehicle collision LMCA extending to LAD dissection Unknown (no thrombolytics) unknown Harada, et al.  Ann Thorac Surg, 2002 14 yo M Motorcycle collision LMCA dissection with left ventricular aneurysm Supportive care with surgical patch angioplasty and anuerysmectomy, mitral valvuloplasty and tricuspid annuloplasty 3 weeks later Discharge to home; doing well 4 years post-operatively Cini, et al  Interact Cardiovasc Thorac Surg, 2008 43 yo F Spontaneous LMCA dissection Surgical revascularization Discharge home Rogers, et al Clin Cardiol, 2007 37 yo F (post-partum) Spontaneous LMCA with LAD involvement Surgical revascularization Discharge home Hazeleger, et al.  Circulation, 2001 29 yo M Tackled in football 2 months prior to arrival LAD dissection; OM dissection Stent Discharge home Smayra, et al.