Sudden cardiac arrest due to traumatic coronary artery dissection. Case report

Dear Editor,
Blunt chest trauma can cause a number of life-threatening cardio­vascular complications, such as myocardial infarction, myocardial rupture, cardiac contusion [1], conduction disorders or arrhythmias [2]. An occasional yet life-threatening complication is the dissection of the coronary arteries. In such cases myocardial infarction is caused by mechanical damage to the coronary artery wall, which may lead to its dissection and/or clotting in its lumen [3].
A 24-year-old patient was admitted to the emergency department to treat the injuries sustained as a result of a traffic accident. The victim was the driver of a passenger car that collided with an excavator at high speed. On admission, the patient was conscious, sleepy, with respiratory insufficiency (Table 1). Intubation and mechanical ventilation were necessary. The trauma examination revealed numerous abrasions to the scalp, chest and abdomen, as well as contused wounds to both lower legs. Computed tomography (CT) polytrauma scanning was performed and demonstrated cerebral oedema, bilateral rib fractures and pulmonary contusion. During the diagnostic procedures, the heart rate significantly accelerated (157 min-1). An ECG was performed, and the concentration of myocardial necrosis markers was determined showing: • hsTnI (high-sensitivity troponin I) 2.444 ng mL–1, • CK-MB mass (creatinine-kinase MB mass) 7.2 ng mL–1.
The ECG visualised the ST segment elevation in the II, III, aVF leads and ST segment depression in the I, aVL and V2–V5 leads. Therefore, an emergency cardiological consultation was requested. According to the cardiologist, the most likely cause of the condition observed was myocardial contusion; there were no indications for invasive diagnostic procedures. One hour and 20 minutes after admission to the emergency department, the patient developed a sudden cardiac arrest due to ventricular fibrillation. Cardiopulmonary resuscitation was undertaken and after 10 minutes spontaneous, insufficient circulation was restored, which required a 0.1 μg kg-1 min-1 infusion of norepinephrine, later increased to 0.2 μg kg-1 min-1. It was decided to transfer the patient to the intensive care unit (ICU) for further treatment.
The patient was admitted to the ICU in an extremely severe general condition. His circulatory and respiratory functions remained impaired; therefore, he required further mechanical ventilation and the infusion of pressor amines. Due to a...


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