This susceptibility is attributable to the LAD’s beta-catenin phosphorylation anatomic relation to the anterior chest wall allowing both direct trauma and deceleration as possible this website mechanisms of trauma [16]. In our case the patient suffered blunt chest trauma as his car collided with a moose. He experienced dissection of the middle part of the LAD (Figure 1). Both coronary artery dissection, intimal tear, plaque rupture or epicardial hematoma might lead to AMI after blunt trauma. However, in 12 published cases of traumatic AMI the coronary angiograms were completely normal [3]. Spasm or lysis of a thrombus might explain AMI in these cases. It should be noted that AMI also has been reported after mild trauma [13, 17, 18]. Figure 1 Coronary

angiogram showing dissection of the middle part of the left anterior descending coronary artery (arrow). In traumatic AMI, the diagnosis might be masked by chest pain originating from other thoracic injuries. ECG may be normal [18], but usually demonstrates abnormalities [15, 16, 19]. Our patient presented with right bundle branch block LCZ696 price (Figure 2). In the case of AMI from coronary artery occlusion, ST-elevations, R-loss and Q-wave development are likely to occur [5, 8, 9]. In our patient, ST-elevations were first recognized sixteen hours after the trauma in the

anterior leads (Figure 3). Prior to this our patient developed hypotension (80/50 mmHg) and compromised peripheral circulation. Echocardiography demonstrated marked apical akinesia and slightly dilated left ventricle with ejection fraction (EF) of approximately 30%. There were no signs of valvular injury or hemopericardium. The condition was in our case first

perceived as severe cardiac contusion. Echocardiography may show regional motion abnormalities in case of ischemia and AMI [5, 9, 14, 15]. It might also demonstrate hemopericardium and valvular Non-specific serine/threonine protein kinase insufficiency [20], if present. Troponin is a sensitive marker of cardiac injury and may be elevated in traumatic coronary artery dissection [8, 9]. The pathological increase may develop several hours after admission [13]. In our patient troponin-T was slightly elevated the first hours after admission and reached a maximum of 11.5 μg/L 30 hours after the accident (Figure 4). Both coronary artery occlusion and dissection without occlusion may be demonstrated by a coronary angiogram [3]. If coronary angiography and revascularization is performed early after onset of ischemia, AMI may be avoided [21]. The time lapse from injury to coronary artery occlusion may vary. AMI has been reported to occur immediately and up to five weeks after trauma [5, 11, 22]. Figure 2 Electrocardiogram on admission showing sinus rhythm and right bundle branch block. Figure 3 Electrocardiogram recorded sixteen hours after the accident showing ST-elevations in the anterior leads. Figure 4 Serum TnT-levels on admission and daily the first seven days of hospitalisation.