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Ventricular Fibrillation Caused by Traumatic Coronary Artery Dissection

Case Reports in Clinical Medicine 2015年第4期4卷 119-123页

作者： Jun-ya Ishikawa naoto morimura Eri Nagai Kyota Nakamura Makoto Shimizu Keiji Uchida Department of Emergency Medicine Yokohama Municipal Citizen’s Hospital Yokohama Japan Advanced Critical Care and Emergency Medical Center Yokohama City University Medical Center Yokohama Japan Department of Anesthesiology Kanagawa Cancer Center Yokohama Japan Department of Cardiology International Goodwill Hospital Yokohama Japan Cardiovascular Center Yokohama City University Medical Center Yokohama Japan

Coronary artery dissection due to blunt chest trauma (traumatic coronary artery dissection [TCAD]) may heal spontaneously, and some surgeons believe that conservative or elective treat-ments are sufficient, provided that there are no progressing ischemic symptoms. However, we report a patient who experienced sudden ventricular fibrillation (VF) during initial medical care for trauma injuries. The 32-year-old woman was riding in a passenger car when an accident occurred, and was subsequently transported to our emergency department. Twelve-lead electrocardiography revealed ST segment elevation in leads II, III, and aVF, although her vital signs remained stable. Therefore, we prioritized assessing the trauma at other sites, and VF suddenly occurred. Coronary angiography was performed with repeated defibrillation and chest compressions, which resulted in recovery of spontaneous circulation. Occlusion was observed in the right coronary artery, which we treated with balloon angioplasty. However, intravascular ultrasonography (IVUS) subsequently revealed coronary artery dissection, a stent was placed, and the patient successfully recovered. Therefore, IVUS may be useful for diagnosing TCAD, and swift intervention is needed if TCAD is detected.

关键词： Coronary Artery Dissection Blunt Chest Trauma Ventricular Fibrillation Acute Myocardial Infarction Intravascular Ultrasonography

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