[Myocardial infarct caused by dissection of the anterior interventricular ramus after blunt thoracic trauma--a case report].

A 23 year old man, having experienced sudden retrosternal pain, radiating to both hemithoraces, with dyspnea at rest was admitted to another hospital. The physical examination of heart and lung was unremarkable, but the patient showed discrete signs of a respiratory infection. Because of the young age and the history of a respiratory infection, the differential diagnosis perimyocarditis was favored and an appropriate treatment was begun. Five days later the patient was transferred to our center for cardiac catheterization and further treatment. After admission the patient was reported to be hit by a football shortly before the onset of symptoms. The electrocardiogram and chemical values showed the signs of myocardial damage with extensive myocardial necrosis. In the coronary arteriography a dissection of the proximal left anterior descending artery of a length of about 2 cm was seen; in the levocardiogram anterior akinesis was verified. Because of the already completed myocardial infarction, the short distance of the lesion to the left main coronary artery, and the restored flow in the left anterior descending, a non-invasive treatment was preferred. A control coronary arteriography five days later showed solely an irregularity of the vessel wall, the coronary dissection was not further demonstrable.