Myocardial infarction is a rare complication of blunt chest trauma. A 47-year-old man who was a chronic smoker presented in the emergency department with multiple injuries of the face, arms, right leg and chest after a motor vehicle accident. The patient’s electrocardiogram showed ST elevation in precordial leads V1–V6. On x-ray examination of the chest, signs of pulmonary venous congestion were seen. Echocardiography showed extensive wall motion abnormality in the region of the left anterior descending artery (LAD) with a left ventricular ejection fraction of 25%. Thrombolytic treatment was not given in view of the multiple injuries. The patient’s coronary angiogram showed dissection of the left main artery and the LAD with total occlusion of the proximal LAD (panel). The right coronary artery (RCA) was anomalously originating from the left coronary sinus and was normal. LAD dissection in relation to blunt chest trauma has been reported but extensive dissection of the left main artery extending into the LAD is extremely rare. 1