CONGRESS ABSTRACT

INTRODUCTION: Coronary dissection (CD) secondary to cardiac contusion in a polytrauma patient is a rare but potentially devasting event. If diagnosed and treated late, it can lead to irreversible outcomes or, in the worst cases, to patient's death. CLINICAL CASE: A 51-year-old male was urgently transported to the emergency department following polytrauma caused by a road accident. Upper limbs x-rays revealed multiple displaced and comminuted fractures, which were manually reduced and immobilized after sedation. During subsequent cardiological evaluation, in the absence of clear chest pain but with diffuse tenderness, an ECG showed an anterolateral STEMI (1). Echocardiogram revealed severe LV dysfunction and a suspected intimal flap image in the ascending aorta. Excluding aortic dissection via contrast-enhanced CT, an emergency coronary angiography was performed. The procedure showed a proximal LAD occlusion secondary to CD (2), which was treated with PTCA on the distal LM, proximal LAD (3a), and proximal CX coronary arteries, effectively restoring coronary flow (3b). To support circulation an IABP was temporarily placed. Post-procedural echocardiography revealed a LVEF of 30% due to akinesia of the IV septum, anterolateral wall, and apex. During hospitalization, a course of inotropic therapy was administered, and anti-ischemic and heart failure medical therapy was optimized, although no significant improvement in LVEF was achieved. For this reason, and due to episodes of NSVT with a narrow RR cycle, five weeks after the acute event, the patient underwent the implantation of a s-ICD for primary prevention. The multiple comorbidities associated with polytrauma were managed with the help of a multidisciplinary team. DISCUSSION: Post-traumatic coronary dissection is a rare event that typically involves the proximal LAD due to its anatomical location just behind the sternum. Early diagnosis is crucial, despite the potential difficulties encountered in polytraumatized patients. Delayed treatment, given the extensive perfusion territory in the case of the proximal LAD, usually results in irreversible outcomes and a prognosis worsening. Therefore, performing an urgent ECG and cardiological evaluation is of primary importance in these patients. CONCLUSION: Possible cardiac involvement might be overlooked in a polytraumatized patient. However, given its significant prognostic impact, it should always be investigated as part of the initial diagnostic workup.