The need for subsequent anti-platelet therapy following stent placement to assure patency limits the utility of these approaches in the multiply injured blunt trauma patient. Some of these patients are already coagulopathic and the addition of these agents can destabilize clots in solid organs leading to life-threatening hemorrhage, or propagate an intracerebral hemorrhage

with grave clinical MK-4827 consequences. In our patient the decision to proceed to coronary bypass was likely due to two factors. Most importantly, the dissection involved the left main coronary artery, which is preferentially treated surgically [23]. Secondly, our patient had a contraindication to percutaneous techniques because of his risk of bleeding. Our approach is supported by a number of successful cases already reported. Korach, Smayra, and Boland all report cases of motor vehicle collisions with resultant LAD coronary dissection that were successfully treated with surgical revascularization [9, 10, 13]. Harada had a similar success story, GDC-0941 chemical structure but the dissection was the left main coronary artery [8].

Redondo reported a mortality in the case of a 45 year-old female diagnosed with a left coronary artery dissection after a motor vehicle collision [11]. Attempts to treat with angioplasty and heparinization were complicated by fatal intra-abdominal hemorrhage. Coronary dissection after blunt chest trauma has been successfully treated with a more conservative approach. Hobelmann reported the case of a 32 year-old male who suffered an RCA dissection after

being elbowed in the chest during basketball [6]. The lesion was successfully treated with eptifibitide, heparin and stents. A focal right coronary artery lesion can be successfully stented, similar to the treatment of lesions in coronary artery disease [23]. Also, the risk of bleeding associated with the use of anticoagulation and anti-platelet agents was lower due to the isolated nature of the trauma. Hazeleger reported an LAD dissection 2 months after a tackle in football which was successfully treated with a stent [5]. Once again, left anterior Selleckchem BIBW2992 descending artery lesions respond Thymidylate synthase well to stent placement [23]. Also, the time interval from injury to diagnosis significantly reduces the risk of bleeding from anticoagulation necessary when stents are utilized. Conclusions Blunt thoracic injury is commonly encountered in a trauma center, and a small fraction of those patients will present with blunt cardiac injuries. The goal of evaluation should be identifying patients with clinically relevant complications related to the cardiac injury and providing the appropriate level of care to meet patients’ needs. We present a review of the diagnostic tools for evaluating blunt cardiac injury.