The patient with cardiac trauma

Paediatric chest wall trauma causing delayed presentation of ventricular arrhythmia

This report describes a paediatric patient presenting with haemodynamically stable non-sustained ventricular tachycardia 1 day after minor blunt chest trauma. Initial laboratory studies, chest X-ray and echocardiography were normal; however, cardiac MRI revealed precordial haematoma, myocardial contusion and small pericardial effusion. Throughout her hospital course, she remained asymptomatic aside from frequent couplets and triplets of premature ventricular contractions. Ectopy was controlled with oral verapamil. This case highlights how significant cardiac injury may be missed with standard diagnostic algorithms.

Transfixing cardiac injury with perforations in stomach, diaphragm and lung: unusual scenario in penetrating trauma

A 23-year-old man suffered a penetrating injury caused by a metallic fragment thrown from a grass-cutting tool, resulting in perforating injuries in the stomach, diaphragm, heart, and lungs.

The anesthetic management of cardiovascular trauma

PURPOSE OF REVIEW

Although little new has been specifically written in recent years regarding the anesthesia management of cardiovascular trauma, two specific areas have seen recent interest and progress, namely the endovascular management of blunt thoracic aortic trauma and commotio cordis, or sudden death following blunt precordial injury.

RECENT FINDINGS

Endovascular repair of thoracic aortic injury has been shown in multiple studies to have short to medium-term mortality and morbidity advantages over repair via thoracotomy. However, long-term (many years) outcome and the expenses required for long-term follow-up of endovascular repairs remain unknown. The risk of commotio cordis during sports activities has become more known to the general population. Recent studies have indicated a very specific limited time during the upstroke of the T-wave to be the critical time for injury, but specific channel involvement is unclear.

SUMMARY

Although transesophageal echocardiography diagnosis of aortic trauma is very sensitive and specific, in general, the lack of immediate availability at all times of skilled echocardiographers and the immediate availability of spiral computed tomography scanners in trauma centers limits the use of transesophageal echocardiography as a first-line diagnostic tool. Endovascular repair of traumatic aortic injury is becoming routine. Commotio cordis is being increasingly recognized as a cause of acute post-traumatic sudden death.

Cardiac contusion: ending myocardial confusion in this capricious syndrome

Symptoms of cardiac contusion are very greatly and sometimes are non recognized or are masked by associated injury in severe chest trauma. Cardiac contusion clinically presents as a spectrum of signs and symptoms of varying severity, ranging from precordial pain, dyspnoea, and non specific ECG changes to increased serum activity of several enzymes, early severe rhythm abnormalities, severe conduction defects and death. We present a fatal case in which the definitive diagnosis of myocardial contusion has proved complex. All clinical data were suggestive of acute myocardial infarction, but the history of chest wall injury and gross and histological examination of the heart and coronary vessels led us to conclude for a cardiac contusion without myocardial infarction. In case of chest blunt trauma, the ECG should be interpreted within the context of the clinical situation, on history of chest wall injury, since a fatal myocardial contusion may occur after apparently mild injury.

Cardiac Trauma (Penetrating and Blunt) and Anesthetic Issues

Patients with blunt or penetrating trauma can require anesthesia and surgery for cardiac injury in the face of noncardiac trauma, or can require anesthesia and surgery for noncardiac injury in the face of cardiac trauma. The true incidence of blunt cardiac trauma is not known, and estimates vary widely with different diagnostic criteria. The diagnosis of traumatic cardiac injury, particularly bluntcardiac injury, may be difficult even with a wealth of available diagnostic tools. Both blunt and penetrating trauma can result is a variety of injuries to cardiac structures. Manifestations of acute traumatic cardiac injury can differ from the clinical manifestations ofsimilar defects in the chronic setting on physical examination, radiography, and in symptomatology. There may be sequelae of traumatic injury which persist, or which may not become apparent for some period of time. Inexpensive, easily-interpreted laboratory criteria for reliably diagnosing cardiac trauma remain. Preexisting cardiacdisease and acute myocardial injury can complicate appropriate resuscitation from massive noncardiac injury. In general, and if unassociated with major noncardiac injuries, patients with cardiac injury be managed with low perioperative mortality.

Delayed diagnosis of cardiac tamponade following isolated blunt abdominal trauma

Traumatic haemopericardium is an uncommon but life threatening condition. It is usually caused by penetrating cardiac injuries or cardiac rupture from blunt chest trauma. We report haemopericardium and cardiac tamponade in a young girl after blunt abdominal trauma. She presented with mild upper abdominal pain, tachycardia and hypotension having been kicked in the abdomen by a horse. No damage was found at laparotomy and she remained haemodynamically unstable. Further investigation found cardiac tamponade and haemopericardium. This was managed by insertion of a pericardial drain using transthoracic echocardiogram guidance, with later drainage in the operating theatre using guidance with a transoesophageal echocardiogram.

Blunt thoraco-abdominal injury

Recent advances in blunt thoraco-abdominal trauma management include improvements in imaging, particularly in trauma bay ultrasound. Indications for non-operative management have expanded for solid organ and aortic injury. The physiology of abdominal compartment syndrome continues to be defined, with resulting improvements in care.