Coronary artery dissection secondary to blunt chest trauma is a rare occurrence recently reported in the Emergency Medicine Journal. The case here is reported of a left anterior descending artery dissection after blunt chest trauma to illustrate a different, more precipitous presentation of this condition after severe trauma. This case report highlights how clinical history can alert to the presence of this complication and how electrocardiography is fundamental to risk stratification after trauma, and discusses management alternatives for this condition in the setting of multi-trauma.