title: Death from undetected acute myocardial infarction secondary to coronary artery dissection after blunt thoracic trauma.
abstract: Blunt thoracic trauma is a common occurrence in automobile accidents. Acute myocardial infarction (AMI) caused by coronary dissection following blunt thoracic trauma is rare. We report a case of healthy 24-year-old man with a history of blunt thoracic injury with subsequent undetected AMI who died of acute decompensated heart failure 4 days after the insult. The autopsy findings showed a 90% luminal narrowing of the left anterior descending coronary artery by dissecting hematoma, 3 cm in length. The myocardium revealed transmural myocardial infarction affecting apex, most part of left ventricular free wall, and interventricular septum. Both lungs were heavy, wet, and noncrepitant. Histological findings of the infarcted myocardium were consistent with 3-5 days post-AMI. Sections from both lungs revealed massive pulmonary edema, reflecting acute decompensated heart failure following a large AMI secondary to coronary dissection. Blunt thoracic trauma may obscure typical chest pain associated with cardiac ischemia especially in cases with a high tolerance for pain.
authors.affiliation: Department of Forensic Medicine, Chonburi Hospital, Chonburi, Thailand.
authors.forename: Supot
authors.initials: S
authors.lastname: Puanglumyai
authors.affiliation: Department of Forensic Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Somboon
authors.initials: S
authors.lastname: Thamtakerngkit
authors.affiliation: Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand. Electronic address: slekawan@hotmail.com.
authors.forename: Suree
authors.initials: S
authors.lastname: Lekawanvijit
mesh_terms: D000063:Accidents, Traffic; D000784:Aortic Dissection / Q000209:etiology* / Q000473:pathology; D003323:Coronary Aneurysm / Q000209:etiology*; D003331:Coronary Vessels / Q000293:injuries*; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000209:etiology* / Q000473:pathology; D013898:Thoracic Injuries / Q000150:complications; D055815:Young Adult
keywords: Acute decompensated heart failure; Acute myocardial infarction; Blunt thoracic trauma; Coronary dissection