If the EKG is abnormal, cardiac monitoring may be reasonable for 24 to 48 hours or until the patient is asymptomatic and hemodynamically stable. Echocardiograms should be reserved for patients presenting with hemodynamic instability and can be helpful in identifying tamponade, pericardial contusion, or apical thrombi. Additional means of testing, such as serial enzyme monitoring, have additional costs with limited clinical benefit. Coronary
artery dissection is a rare clinical condition, with variable Nutlin-3a nmr causes including trauma, iatrogenic lesions from angiography, and spontaneous dissections. Despite the etiology of the dissection, JQ1 cell line treatment is dependent upon the location of the lesion. Patients with LMCA lesions or those with a high-risk of bleeding will likely need to undergo coronary bypass. Lesions isolated to the LAD or RCA, and with isolated trauma, can be treated with percutaneous techniques. In our GSK872 patient sustained a high-risk blunt chest trauma from a motor vehicle collision. An EKG was ordered to evaluate his symptoms, and the screening test initiated a diagnostic evaluation. Based on those findings, additional diagnostic tests–the cardiac enzymes and angiogram–were justified and provided rapid diagnosis of the coronary artery dissection. Prompt recognition, evaluation and
treatment resulted in immediate surgical revascularization and discharge to home on hospital day 19. References 1. Pasquale MKNJC: EAST Practice Management Guidelines for Screening of Blunt Cardiac Injury. Eastorg. [Practice Guidelines] 1998. 2. Christensen MA, Sutton KR: Myocardial Contusion. Am J Crit Care 1993, 2:28–34.PubMed 3. Biffl WL, Moore FA, Moore EE, Sauaia A, Read RA, Burch JM: Cardiac enzymes are irrelevant in the patient with suspected myocardial contusion. Am J Surg 1994,168(6):523–7. discussion 7–8.CrossRefPubMed 4. Greenberg J, Salinger M, Weschler F, Edelman B, Williams R: Circumflex Pyruvate dehydrogenase lipoamide kinase isozyme 1 coronary artery dissection following waterskiing. Chest 1998,113(4):1138–40.CrossRefPubMed 5. Hazeleger R, van der Wieken R, Slagboom T, Landsaat P: Coronary dissection and occlusion due to sports injury. Circulation 2001,103(8):1174–5.PubMed
6. Hobelmann AJCPEBH: Case of the month: Right coronary artery dissection following sports-related blunt trauma. Emerg Med J 2006, 23:580–3.CrossRef 7. Leong D, Brown M: Blunt traumatic dissection of the proximal left anterior descending artery. Emerg Med J 2006,23(12):e67.CrossRefPubMed 8. Harada H, Honma Y, Hachiro Y, Mawatari T, Abe T: Traumatic coronary artery dissection. Ann Thorac Surg 2002,74(1):236–7.CrossRefPubMed 9. Korach A, Hunter CT, Lazar HL, Shemin RJ, Shapira OM: OPCAB for acute LAD dissection due to blunt chest trauma. Ann Thorac Surg 2006,82(1):312–4.CrossRefPubMed 10. Smayra T, Noun R, Tohme-Noun C: Left anterior descending coronary artery dissection after blunt chest trauma: assessment by multi-detector row computed tomography.