title: Right coronary artery occlusion secondary to blunt trauma.
abstract: The heart lies in a vulnerable position when the chest is subjected to direct blunt trauma. Acute occlusion of a coronary artery from blunt chest trauma is rare, with occlusion of the right coronary artery at its origin recorded only twice in the English literature. A young male unrestrained driver sustained an acute deceleration injury with significant chest trauma when he crashed, crushing the steering wheel against his chest. Creatine phosphokinase isoenzymes were initially 2% of the total and 8% 12 h later. There were marked electrocardiographic changes, and an echocardiogram revealed abnormal left ventricular systolic function with an akinetic inferior-posterior wall and right ventricular enlargement. A wide mediastinum and mechanism of injury led to the performance of aortography which failed to disclose a right coronary vessel. Subsequently coronary angiography confirmed acute occlusion of the proximal right coronary artery. Because of other associated injuries, nonoperative medical management was successfully utilized.
authors.affiliation: Division of Trauma Surgery, St. Louis University Medical Center, MO 63110-0250.
authors.forename: M J
authors.initials: MJ
authors.lastname: Shapiro
authors.forename: C
authors.initials: C
authors.lastname: Wittgen
authors.forename: M S
authors.initials: MS
authors.lastname: Flynn
authors.forename: D A
authors.initials: DA
authors.lastname: Zuckerman
authors.forename: R M
authors.initials: RM
authors.lastname: Durham
authors.forename: J E
authors.initials: JE
authors.lastname: Mazuski
mesh_terms: D000328:Adult; D001157:Arterial Occlusive Diseases / Q000209:etiology*; D003327:Coronary Disease / Q000209:etiology*; D003331:Coronary Vessels / Q000293:injuries*; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000209:etiology; D013898:Thoracic Injuries; D014949:Wounds, Nonpenetrating