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Doornkamp RN, van Winden DF, Buiten MS, Josephus Jitta D. Karate kick-induced myocardial contusion. BMJ Case Rep 2024; 17:e257082. [PMID: 38272515 PMCID: PMC10826487 DOI: 10.1136/bcr-2023-257082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2023] [Indexed: 01/27/2024] Open
Abstract
Myocardial contusion should be suspected in a selected patient group with blunt thoracic trauma, who have elevated troponin, ECG changes and/or haemodynamical instability. Echocardiography is useful for direct visualisation of possible complications. In stable conditions, MRI allows for good visualisation of the heart and can confirm a suspected myocardial contusion as well as demonstrate the extent of myocardial damage. Based on the present literature, the authors developed a diagram for the diagnostic approach of a patient with suspected myocardial contusion.
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Affiliation(s)
- Ruben N Doornkamp
- Department of Emergency Medicine, Medisch Centrum Haaglanden Westeinde, Den Haag, Zuid-Holland, The Netherlands
| | - Daniëlle Fm van Winden
- Department of Emergency Medicine, Medisch Centrum Haaglanden Westeinde, Den Haag, Zuid-Holland, The Netherlands
| | - Maurits S Buiten
- Department of Cardiology, Medisch Centrum Haaglanden Westeinde, Den Haag, Zuid-Holland, The Netherlands
| | - Djike Josephus Jitta
- Department of Cardiology, Medisch Centrum Haaglanden Westeinde, Den Haag, Zuid-Holland, The Netherlands
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2
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Kyriazidis IP, Jakob DA, Vargas JAH, Franco OH, Degiannis E, Dorn P, Pouwels S, Patel B, Johnson I, Houdlen CJ, Whiteley GS, Head M, Lala A, Mumtaz H, Soler JA, Mellor K, Rawaf D, Ahmed AR, Ahmad SJS, Exadaktylos A. Accuracy of diagnostic tests in cardiac injury after blunt chest trauma: a systematic review and meta-analysis. World J Emerg Surg 2023; 18:36. [PMID: 37245048 DOI: 10.1186/s13017-023-00504-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 05/19/2023] [Indexed: 05/29/2023] Open
Abstract
INTRODUCTION The diagnosis of cardiac contusion, caused by blunt chest trauma, remains a challenge due to the non-specific symptoms it causes and the lack of ideal tests to diagnose myocardial damage. A cardiac contusion can be life-threatening if not diagnosed and treated promptly. Several diagnostic tests have been used to evaluate the risk of cardiac complications, but the challenge of identifying patients with contusions nevertheless remains. AIM OF THE STUDY To evaluate the accuracy of diagnostic tests for detecting blunt cardiac injury (BCI) and its complications, in patients with severe chest injuries, who are assessed in an emergency department or by any front-line emergency physician. METHODS A targeted search strategy was performed using Ovid MEDLINE and Embase databases from 1993 up to October 2022. Data on at least one of the following diagnostic tests: electrocardiogram (ECG), serum creatinine phosphokinase-MB level (CPK-MB), echocardiography (Echo), Cardiac troponin I (cTnI) or Cardiac troponin T (cTnT). Diagnostic tests for cardiac contusion were evaluated for their accuracy in meta-analysis. Heterogeneity was assessed using the I2 and the QUADAS-2 tool was used to assess bias of the studies. RESULTS This systematic review yielded 51 studies (n = 5,359). The weighted mean incidence of myocardial injuries after sustaining a blunt force trauma stood at 18.3% of cases. Overall weighted mean mortality among patients with blunt cardiac injury was 7.6% (1.4-36.4%). Initial ECG, cTnI, cTnT and transthoracic echocardiography TTE all showed high specificity (> 80%), but lower sensitivity (< 70%). TEE had a specificity of 72.1% (range 35.8-98.2%) and sensitivity of 86.7% (range 40-99.2%) in diagnosing cardiac contusion. CK-MB had the lowest diagnostic odds ratio of 3.598 (95% CI: 1.832-7.068). Normal ECG accompanied by normal cTnI showed a high sensitivity of 85% in ruling out cardiac injuries. CONCLUSION Emergency physicians face great challenges in diagnosing cardiac injuries in patients following blunt trauma. In the majority of cases, joint use of ECG and cTnI was a pragmatic and cost-effective approach to rule out cardiac injuries. In addition, TEE may be highly accurate in identifying cardiac injuries in suspected cases.
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Affiliation(s)
| | - Dominik A Jakob
- Department of Emergency Medicine, Inselspital University Hospital of Bern, Bern, Switzerland
| | - Juliana Alexandra Hernández Vargas
- Department of Global Public Health and Bioethics, Julius Center for Health Sciences and Primary Care, University Medical Center (UMC) Utrecht, Utrecht, The Netherlands
| | - Oscar H Franco
- Department of Global Public Health and Bioethics, Julius Center for Health Sciences and Primary Care, University Medical Center (UMC) Utrecht, Utrecht, The Netherlands
| | - Elias Degiannis
- Department of Emergency Medicine, Inselspital University Hospital of Bern, Bern, Switzerland
- Department of Surgery, University of Witwatersrand Medical School, Johannesburg, South Africa
| | - Patrick Dorn
- Department of Thoracic Surgery, Inselspital, University Hospital of Bern, Bern, Switzerland
| | - Sjaak Pouwels
- Department of General, Abdominal and Minimally Invasive Surgery, Helios Klinikum Krefeld, Krefeld, Germany
| | - Bijendra Patel
- Department of General Surgery, Barts Cancer Institute, London, UK
| | - Ian Johnson
- Department of Anaesthesia & Intensive Care, Betsi Cadwaladr University Health Board, Bodelwyddan, Wales, UK
| | - Christopher John Houdlen
- Department of General Surgery, Betsi Cadwaladr University Health Board, Bangor, LL57 2PW, Wales, UK
| | - Graham S Whiteley
- Department of General Surgery, Betsi Cadwaladr University Health Board, Bangor, LL57 2PW, Wales, UK
| | - Marion Head
- Department of General Surgery, Betsi Cadwaladr University Health Board, Bangor, LL57 2PW, Wales, UK
| | - Anil Lala
- Department of General Surgery, Betsi Cadwaladr University Health Board, Bangor, LL57 2PW, Wales, UK
| | - Haroon Mumtaz
- Department of Trauma and Orthopaedic Surgery, Betsi Cadwaladr University Health Board, Bangor, Wales, UK
| | - J Agustin Soler
- Department of Trauma and Orthopaedic Surgery, Betsi Cadwaladr University Health Board, Bangor, Wales, UK
| | - Katie Mellor
- Department of General Surgery, Betsi Cadwaladr University Health Board, Bangor, LL57 2PW, Wales, UK
| | - David Rawaf
- Department of Surgery, South West London Orthopaedic Centre, London, UK
| | - Ahmed R Ahmed
- Department of General Surgery, Imperial College London, London, UK
| | - Suhaib J S Ahmad
- Department of Emergency Medicine, Inselspital University Hospital of Bern, Bern, Switzerland.
- Department of General Surgery, Betsi Cadwaladr University Health Board, Bangor, LL57 2PW, Wales, UK.
| | - Aristomenis Exadaktylos
- Department of Emergency Medicine, Inselspital University Hospital of Bern, Bern, Switzerland
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Nair L, Winkle B, Senanayake E. Managing blunt cardiac injury. J Cardiothorac Surg 2023; 18:71. [PMID: 36765392 PMCID: PMC9912488 DOI: 10.1186/s13019-023-02146-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 01/09/2023] [Indexed: 02/12/2023] Open
Abstract
Blunt cardiac injury (BCI) encompasses a spectrum of pathologies ranging from clinically silent, transient arrhythmias to deadly cardiac wall rupture. Of diagnosed BCIs, cardiac contusion is most common. Suggestive symptoms may be unrelated to BCI, while some injuries may be clinically asymptomatic. Cardiac rupture is the most devastating complication of BCI. Most patients who sustain rupture of a heart chamber do not reach the emergency department alive. The incidence of BCI following blunt thoracic trauma remains variable and no gold standard exists to either diagnose cardiac injury or provide management. Diagnostic tests should be limited to identifying those patients who are at risk of developing cardiac complications as a result of cardiac in jury. Therapeutic interventions should be directed to treat the complications of cardiac injury. Prompt, appropriate and well-orchestrated surgical treatment is invaluable in the management of the unstable patients.
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Affiliation(s)
- Lawrence Nair
- Department of Cardiothoracic Surgery, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD, 4032, Australia.
| | - Brendan Winkle
- Department of Surgery, Royal Darwin Hospital, Darwin, NT, Australia
| | - Eshan Senanayake
- Department of Cardiothoracic Surgery, Queen Elizabeth Hospital, Birmingham, United Kingdom
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Cardiac contusions in the acute care setting: Historical background, evaluation and management. Am J Emerg Med 2022; 61:152-157. [PMID: 36116330 DOI: 10.1016/j.ajem.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 09/01/2022] [Accepted: 09/06/2022] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Albeit described since 1763, cardiac contusions is still an under-recognised clinical condition in the acute care setting. This evidence-based review aims to provide an overview of the topic by focusing on etiopathogenesis, classification and clinical presentation of patients with cardiac contusions, as well as on the diagnostic work-up and therapy options available for this subset population in the acute care setting. METHODS A targeted research strategy was performed using PubMed, MEDLINE, Embase and Cochrane Central databases up to June 2022. The literature search was conducted using the following keywords (in Title and/or Abstract): ("cardiac" OR "heart" OR "myocardial") AND ("contusion"). All available high-quality resources written in English and containing information on epidemiology, etiopathogenesis, clinical findings, diagnosis and management of cardiac contusions were included in our research. RESULTS Biochemical samples of cardiac troponins together with a 12‑lead ECG appear to be sufficient screening tools in hemodynamically stable subjects, while cardiac ultrasound provides a further diagnostic clue for patients with hemodynamic instability or those more likely to have a significant cardiac contusion. CONCLUSIONS The management of patients with suspected cardiac contusion remains a challenge in clinical practice. For this kind of patients a comprehensive diagnostic approach and a prompt emergency response are required, taking into consideration the degree of severity and clinical impairment of associated traumatic injuries.
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White A, Cullen P, Hinchion J. Traumatic avulsion of the tricuspid valve: an unusual cardiac complication of an equine accident. BMJ Case Rep 2022; 15:e248580. [PMID: 35606029 PMCID: PMC9125735 DOI: 10.1136/bcr-2021-248580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2022] [Indexed: 11/04/2022] Open
Abstract
A stablehand in his 20s presented with increasing dyspnoea on exertion and chest pain months after being kicked directly in the chest by a horse. Further investigations revealed severe isolated, primary tricuspid regurgitation due to partial avulsion of the anterior leaflet. Open surgical repair was successfully performed from which he recovered uneventfully with resolution of his symptoms and minimal residual tricuspid regurgitation. Although uncommon, blunt force trauma to the chest is becoming increasingly recognised as a rare cause of tricuspid regurgitation. Symptoms may be insidious, and a high index of suspicion is required to avoid missing the diagnosis.
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Affiliation(s)
- Alexandra White
- Cardiothoracic Surgery, Galway University Hospitals, Galway, Ireland
| | - Paul Cullen
- Cardiothoracic Surgery, Cork University Hospital, Cork, Ireland
| | - John Hinchion
- Cardiothoracic Surgery, Cork University Hospital, Cork, Ireland
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Hon KL, Tan YW, Leung KKY, Hui WF, Cheung WL, Chung FS. Rib Fractures Postcardiac Chest Compressions. Pediatr Emerg Care 2022; 38:e1236. [PMID: 35358153 DOI: 10.1097/pec.0000000000002687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Patel KM, Kumar NS, Desai RG, Mitrev L, Trivedi K, Krishnan S. Blunt Trauma to the Heart: A Review of Pathophysiology and Current Management. J Cardiothorac Vasc Anesth 2021; 36:2707-2718. [PMID: 34840072 DOI: 10.1053/j.jvca.2021.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 10/09/2021] [Accepted: 10/13/2021] [Indexed: 11/11/2022]
Abstract
Blunt cardiac injury (BCI), defined as an injury to the heart from blunt force trauma, ranges from minor to life-threatening. The majority of BCIs are due to motor vehicle accidents; however, injuries caused by falls, blasts, and sports-related injuries also can be sources of BCI. A significant proportion of patients with BCI do not survive long enough to receive medical care, succumbing to their injuries at the scene of the accident. Additionally, patients with blunt trauma often have coexisting injuries (brain, spine, orthopedic) that can obscure the clinical picture; therefore, a high degree of suspicion often is required to diagnose BCI. Traditionally, hemodynamically stable injuries suspicious for BCI have been evaluated with electrocardiograms and chest radiographs, whereas hemodynamically unstable BCIs have received operative intervention. More recently, computed tomography and echocardiography increasingly have been utilized to identify injuries more rapidly in hemodynamically unstable patients. Transesophageal echocardiography can play an important role in the diagnosis and management of several BCIs that require operative repair. Close communication with the surgical team and access to blood products for potentially massive transfusion also play key roles in maintaining hemodynamic stability. With proper surgical and anesthetic care, survival in cases involving urgent cardiac repair can reach 66%-to-75%. This narrative review focuses on the types of cardiac injuries that are caused by blunt chest trauma, the modalities and techniques currently used to diagnose BCI, and the perioperative management of injuries that require surgical correction.
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Affiliation(s)
- Kinjal M Patel
- Adult Cardiothoracic Anesthesiology, Cooper University Healthcare, Cooper Medical School of Rowan University, Camden, NJ.
| | - Nakul S Kumar
- Cardiothoracic and Critical Care Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH
| | - Ronak G Desai
- Adult Cardiothoracic Anesthesiology, Cooper University Healthcare, Cooper Medical School of Rowan University, Camden, NJ
| | - Ludmil Mitrev
- Adult Cardiothoracic Anesthesiology, Cooper University Healthcare, Cooper Medical School of Rowan University, Camden, NJ
| | - Keyur Trivedi
- Adult Cardiothoracic Anesthesiology, Cooper University Healthcare, Cooper Medical School of Rowan University, Camden, NJ
| | - Sandeep Krishnan
- Adult Cardiothoracic Anesthesiology, Wayne State University School of Medicine Pontiac, MI
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Janicic D, Simatovic M, Roljic Z, Krupljanin L, Karabeg R. Urgent Surgical Treatment of Blunt Chest Trauma Followed by Cardiac and Pericardial Injuries. Med Arch 2021; 74:115-118. [PMID: 32577052 PMCID: PMC7296422 DOI: 10.5455/medarh.2020.74.115-118] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Introduction Widespread opinion that penetrating chest injuries are more urgent, in terms of treatment and care, contributed to underestimation of the urgency of blunt chest trauma, which in most cases is treated conservatively. It remains an open question frequency when the injuries of the heart and pericardium are not timely diagnosed and surgically treated. Aim To demonstrate the importance of well-timed surgical treatment of blunt chest trauma, when coupled with cardiac and pericardial injuries. Methods At the Thoracic Surgery Clinic of the University Clinical Centre Banja Luka, Bosnia and Herzego vina, during period of 10 years (01.01. 2008 - 31.01.2018.), the total of 66 patients were treated for urgent thoracotomy due to clinically and radiologically unclear findings after blunt chest trauma. In general, diagnostic examinations, apart from laboratory analysis, included radiological imaging and Multi Slice Computed Tomography (MSCT) of the chest, followed by an ultrasound of the heart in cases when sternum was injured or when pericardial tamponade was suspected. Results presented in the study where obtained from the retrospective analysis of patients data. This work presents a retrospective observational cross-sectional study, which results in the assessment of the correctness of a particular diagnostic test. Statistical methods used descriptive statistics, counting measures (frequencies and percentages), central tendency measures (arithmetic mean), variability measures (standard deviation). Results Sixty six patients were treated with urgent thoracotomy after a blunt trauma of the chest due to the unclear clinical and radiological finding. In the case of 11 patients (10 men and 1 woman), presenting 16.6% of the total sample, pericardial and cardiac injuries were detected and treated intraoperatively. Further, in the case of the one patient, pericardiotomy and suturing of the right heart chamber where performed, with the creation of a pericardial window. Transthoracic echocardiogram was not used as the primary screening module, but rather as a diagnostic test for patients who had unexplained hypotension and arrhythmia. Radiographs of the chest showed cardiomegaly with or without epicardial fat pad sign suggesting a pericardial effusion. Conclusion Blunt cardiac and pericardial injuries represent a serious therapeutic problem, which, if not treated properly, result in a high mortality rate. Echocardiography is the primary diagnostic method for initial detection of pericardial effusion. Pericardial fluid first accumulates posterior to the heart, when the patient is examined in the supine position. As the effusion increases, it extends laterally and with large effusions the echo-free space expands to surround the entire heart. The size of the effusion may be graded as small ( echo free spaces in diastole <10 mm, corresponding to approxymately 300 ml), moderate (10-20 mm, corresponding to 500 ml), and large ( >20 mm, corresponding to >700 ml). When the ability of the pericardium to stretch is exceeded by rapid or massive accumulation of fluid, any additional fluid causes the pressure with the pericardial sac. Early recognition, pericardiotomy with pericardial window creation and/or ventricular rupture suture remain the "gold standard" in the treatment of blunt cardiac and pericardial injuries.
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Affiliation(s)
- Dusan Janicic
- Clinic for Thoracic Surgery, University Clinical Center Republic of Srpska, Banja Luka, Bosnia and Herzegovina
| | - Milan Simatovic
- Clinic for General and Abdominal Surgery, University Clinical Center Republic of Srpska, Banja Luka, Bosnia and Herzegovina
| | - Zoran Roljic
- Clinic for Vascular Surgery, University Clinical Center Republic of Srpska, Banja Luka, Bosnia and Herzegovina
| | - Ljiljana Krupljanin
- Clinic for Thoracic Surgery, University Clinical Center Republic of Srpska, Banja Luka, Bosnia and Herzegovina
| | - Reuf Karabeg
- Private Clinic "Karabeg" Sarajevo, Bosnia and Herzegovina.,Faculty of Medicine,University of Sarajevo, Sarajevo, Bosnia and Herzegovina
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Mansour J, Raptis DA, Bhalla S. Multimodality Imaging of Cardiac Trauma. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2021. [DOI: 10.1007/s11936-021-00907-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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10
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Long B, Long DA, Tannenbaum L, Koyfman A. An emergency medicine approach to troponin elevation due to causes other than occlusion myocardial infarction. Am J Emerg Med 2020; 38:998-1006. [DOI: 10.1016/j.ajem.2019.12.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 11/18/2019] [Accepted: 12/04/2019] [Indexed: 02/06/2023] Open
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Qamar SR, Wu Y, Nicolaou S, Murray N. State of the Art Imaging Review of Blunt and Penetrating Cardiac Trauma. Can Assoc Radiol J 2020; 71:301-312. [PMID: 32066272 DOI: 10.1177/0846537119899200] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Traumatic cardiovascular injuries are only second to the central nervous system injuries as a cause of death in young adult population. Multidetector computed tomography is the gold standard diagnostic modality in patients with blunt or penetrating chest trauma and clinical suspicion of cardiac injury. The imaging spectrum of cardiac injuries includes but not limits to pericardial rupture, myocardial contusions, valve rupture, coronary artery injuries, cardiac herniations, and cardiac tamponade. In this review article, we discuss clinical presentation, types, and mechanism of cardiac trauma with emphasis on the imaging findings and illustrations in blunt, penetrating traumatic, and iatrogenic cardiac injuries.
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Affiliation(s)
- Sadia Raheez Qamar
- Emergency and Trauma Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Yuhao Wu
- Department of Medical Imaging, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Savvas Nicolaou
- Emergency and Trauma Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nicolas Murray
- Emergency and Trauma Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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Van Lieshout EMM, Verhofstad MHJ, Van Silfhout DJT, Dubois EA. Diagnostic approach for myocardial contusion: a retrospective evaluation of patient data and review of the literature. Eur J Trauma Emerg Surg 2020; 47:1259-1272. [PMID: 31982920 PMCID: PMC8321993 DOI: 10.1007/s00068-020-01305-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 01/14/2020] [Indexed: 11/25/2022]
Abstract
Purpose Myocardial contusion can be a life-threatening condition in patients who sustained blunt thoracic trauma. The diagnostic approach remains a subject of debate. The aim of this study was to determine the sensitivity and specificity of echocardiography, electrocardiography, troponins T and I (TnT and TnI), and creatine kinase muscle/brain (CK-MB) for identifying patients with a myocardial contusion following blunt thoracic trauma. Methods Sensitivity and specificity were first determined in a 10-year retrospective cohort study and second by a systematic literature review with meta-analysis. Results Of the 117 patients in the retrospective study, 44 (38%) were considered positive for myocardial contusion. Chest X-ray, chest CT scan, electrocardiograph, and echocardiography had poor sensitivity (< 15%) but good specificity (≥ 90%). Sensitivity to cardiac biomarkers measured at presentation ranged from 59% for TnT to 77% for hs-TnT, specificity ranged from 63% for CK-MB to 100% for TnT. The systematic literature review yielded 28 studies, with 14.5% out of 7242 patients reported as positive for myocardial contusion. The pooled sensitivity of electrocardiography, troponin I, and CK-MB was between 62 and 71%, versus only 45% for echocardiography and 38% for troponin T. The pooled specificity ranged from 63% for CK-MB to 85% for troponin T and 88% for echocardiography. Conclusion The best diagnostic approach for myocardial contusion is a combination of electrocardiography and measurement of cardiac biomarkers. If abnormalities are found, telemonitoring is necessary for the early detection of life-threatening arrhythmias. Chest X-ray and CT scan may show other thoracic injuries but provide no information on myocardial contusion. Electronic supplementary material The online version of this article (10.1007/s00068-020-01305-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Esther M M Van Lieshout
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - Michael H J Verhofstad
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Dirk Jan T Van Silfhout
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Eric A Dubois
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
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Kawall T, Seecheran RV, Seecheran VK, Persad SA, Jagdeo CL, Seecheran NA. “Shot to the Heart”: Case Report and Concise Review of Cardiac Gunshot Injury. J Investig Med High Impact Case Rep 2020; 8:2324709620951652. [PMID: 32815420 PMCID: PMC7444102 DOI: 10.1177/2324709620951652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Penetrative cardiac injury can often result in life-threatening sequelae such as myocardial contusion or rupture, coronary vessel and valvular damage, pericardial effusion with tamponade, and arrhythmias of which gunshot injury is a chief culprit. We report a case of a suspected acute coronary syndrome after a cardiac gunshot injury that was conservatively managed.
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Affiliation(s)
- Tiffany Kawall
- North Central Regional Health Authority, Mt. Hope, Trinidad and Tobago
| | | | | | | | - Cathy-Lee Jagdeo
- North Central Regional Health Authority, Mt. Hope, Trinidad and Tobago
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Siado SA, Martínez-Montalvo CM, Osorio M, Gómez A, Jiménez HC. Utilidad de las pruebas diagnósticas en el trauma cardiaco cerrado. REVISTA COLOMBIANA DE CIRUGÍA 2019. [DOI: 10.30944/20117582.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Enzymatic Parameters at Admission and the Risk of Death in Politrauma Patientrs with Associated Thoracic Trauma. ARS MEDICA TOMITANA 2019. [DOI: 10.2478/arsm-2018-0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Polytrauma patients represent one of the most challenging medical conditions. Developing methods of assessing the risk of death in these patients is a continous effort for the medical field. In this study we evaluate the creatine kinaze isoenzyme MB (CK-MB) and troponin as markers of increased risk of death in the first 24 hours after admission in polytrauma patients with associated thoracic trauma.
The study was conducted on 33 patients treated in the emergency department of County Clinical Emergency Hospital Constanta between 2014 and 2017.
The results of the study suggest that CK-MB does not offer additional information related to the risk of death in these patients, while in the case of troponin, higher values were observed in the patients that didn’t survive after 24 hours of followup.
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Ruby RE, Wong DM, Ware WA, Ackermann MR. Myocardial Fibrosis and Ventricular Tachyarrhythmia in a Thoroughbred Filly. J Equine Vet Sci 2018. [DOI: 10.1016/j.jevs.2018.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Abstract
CLINICAL INTRODUCTION: A man in his late 40s presented with severe chest pain and progressive dyspnoea after hitting a tree at high speed during a bike ride in the woods. On admission, the patient appeared agitated, pale and sweaty. Core temperature was 35.5°C, respiratory rate 35/min and blood pressure 90/50 mm Hg with a regular pulse at 110 beats/min. Physical examination revealed multiple sternal bruises, distended jugular veins and muffled heart sounds (figure 1A). Lactate level was 4.4 mmol/L (normal <2.0 mmol/L) and high-sensitivity cardiac troponin T 0.142 mcg/L (normal <0.005 mcg/L). An ECG and a total body CT scan were performed (figure 1B,C).heartjnl;104/20/1706/F1F1F1Figure 1(A) Multiple sternal bruises. (B) ECG on admission. (C) Thoracic CT. QUESTION WHAT IS THE MOST LIKELY DIAGNOSIS?: Inferior myocardial infarction with right ventricular involvement.Cardiac contusion with tamponade.Commotio cordis.Aortic laceration.
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Affiliation(s)
- Jerrold Spapen
- Department of Cardiology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Stijn Lochy
- Department of Cardiology, Universitair Ziekenhuis Brussel, Brussels, Belgium
- Department of Intensive Care Medicine, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Vincent Michiels
- Department of Cardiology, Universitair Ziekenhuis Brussel, Brussels, Belgium
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Krexi L, Sheppard MN. Blow/trauma to the chest and sudden cardiac death: Commotio cordis and contusio cordis are leading causes. MEDICINE, SCIENCE, AND THE LAW 2018; 58:93-96. [PMID: 29360016 DOI: 10.1177/0025802418754961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Background In forensic practice, a blow to the chest can lead to sudden cardiac death (SCD). Commotio cordis and contusio cordis are leading causes. Methods From a database of 4678 patients who suffered from SCD, we found three patients with commotio cordis and two patients with contusio cordis. All the patients were examined macroscopically and microscopically and had negative toxicology screen. Results The three patients who died due to commotio cordis were young males (16, 23 and 38 years old). The circumstances of death were: a blow to the chest by a football, by a friend during a party and during an assault. The hearts were completely normal at autopsy. The two patients who had contusio cordis were older males (42 and 63 years old). Both patients died during traffic accidents. At autopsy, one had significant contusion over the left ventricle, and the second had contusion over the right ventricle. Conclusion This study indicates that a blow to the chest is very important to document in the circumstances of death, and a detailed history is vital. It raises the left ventricular intra-cavitary pressure, leading to commotio cordis with immediate death with a normal heart. Blunt chest trauma can cause direct myocardial lesions, with acute changes leading to contusio cordis.
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Affiliation(s)
- Lydia Krexi
- Cardiac Risk in the Young, Department of Cardiovascular Pathology, Cardiovascular Sciences Research Centre, St George's University of London, UK
| | - Mary N Sheppard
- Cardiac Risk in the Young, Department of Cardiovascular Pathology, Cardiovascular Sciences Research Centre, St George's University of London, UK
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Gratton R, Olaussen A, Hassan M, Thaveenthiran P, Fitzgerald MC, Mitra B. Diagnostic performance of the cardiac FAST in a high-volume Australian trauma centre. JOURNAL OF EMERGENCY MEDICINE, TRAUMA AND ACUTE CARE 2017. [DOI: 10.5339/jemtac.2017.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Background: Cardiac injury is uncommon, but it is important to diagnose, in order to prevent subsequent complications. Extended focused assessment with sonography in trauma (eFAST) allows rapid evaluation of the pericardium and thorax. The objective of this study was to describe cardiac injuries presenting to a major trauma centre and the diagnostic performance of eFAST in detecting haemopericardium as well as broader cardiac injuries. Methods: Data of patients with severe injuries and diagnosed cardiac injuries (Injury Severity Score >12 and AIS 2008 codes for cardiac injuries) were extracted from The Alfred Trauma Registry over a four-year period from July 2010 to June 2014. The initial eFAST results were compared to those of the final diagnosis, which were determined after analysing imaging results and intraoperative findings. Results: Thirty patients who were identified with cardiac injuries met the inclusion criteria. Among these, 22 patients sustained injuries under the scope of eFAST, of which a positive eFAST scan in the pericardium was reported in 13 (59%) patients, while nine (41%) patients had a negative scan. This resulted in a sensitivity of 59% (95% CI: 36.7%–78.5%). The sensitivity of detecting any cardiac injuries was lower at 43.3% (95% CI: 26.0–62.3). Conclusions: The low sensitivities of eFAST for detecting cardiac injuries and haemopericardium demonstrate that a negative result cannot be used in isolation to exclude cardiac injuries. A high index of suspicion for cardiac injury remains essential. Adjunct diagnostic modalities are indicated for the diagnosis of cardiac injury following major trauma.
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Affiliation(s)
| | - Alexander Olaussen
- 2Department of Community Emergency Health and Paramedic Practice, Monash University, Melbourne, Australia
- 3Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Australia
- 4Trauma Service, The Alfred Hospital, Melbourne, Australia
- 5National Trauma Research Institute, The Alfred Hospital, Melbourne, Australia
| | - Mariam Hassan
- 5National Trauma Research Institute, The Alfred Hospital, Melbourne, Australia
| | | | - Mark C. Fitzgerald
- 4Trauma Service, The Alfred Hospital, Melbourne, Australia
- 5National Trauma Research Institute, The Alfred Hospital, Melbourne, Australia
| | - Biswadev Mitra
- 3Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Australia
- 5National Trauma Research Institute, The Alfred Hospital, Melbourne, Australia
- 6Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia
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Abstract
Monitoring of the injured patient is important. It includes clinical assessment, following the ABCDE approach, and the use of instruments found from the prehospital to critical care setting. Correctly used, these provide important information about the patient's current physiological state and response to treatment plus diagnostic and prognostic implications that are useful to the clinician involved in the care of injured patients.
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Affiliation(s)
- Jonathan Hulme
- Birmingham School of Anaesthesia, West Midlands Deanery, Birmingham, UK; West Midlands Central Accident Resuscitation Emergency (CARE) Team, Selly Oak Hospital, Birmingham, UK
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Alborzi Z, Zangouri V, Paydar S, Ghahramani Z, Shafa M, Ziaeian B, Radpey MR, Amirian A, Khodaei S. Diagnosing Myocardial Contusion after Blunt Chest Trauma. J Tehran Heart Cent 2016; 11:49-54. [PMID: 27928254 PMCID: PMC5027160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A myocardial contusion refers to a bruise of the cardiac muscle, the severity of which can vary depending on the severity of the injury and when the injury occurs. It is a major cause of rapid death which happens after blunt chest trauma and should be suspected at triage in the emergency department. We demonstrated that suspected myocardial contusion patients who have normal electrocardiograms (ECGs) and biomarker tests can be safely discharged. However, if the test results are abnormal, the next steps should be echocardiography and more advanced measures. Diagnosing myocardial contusion is very difficult because of its nonspecific symptoms. If a myocardial contusion happens, cardiogenic shock or arrhythmia must be anticipated, and the patient must be carefully monitored.
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Affiliation(s)
- Zahra Alborzi
- Department of Cardiology, Medical School, Yasouj University of Medical Sciences, Yasouj, Iran.
| | - Vahid Zangouri
- Department of General Surgery, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Shahram Paydar
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.,Corresponding Author: Shahram Paydar, Associate Professor of Trauma Surgery, Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Chamran Boulevard, Shiraz, Iran. 71948-15711. Tel: +98 71 36360697. Fax: +98 71 36254206..
| | - Zahra Ghahramani
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Masih Shafa
- Department of Cardiac Surgery, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Bizhan Ziaeian
- Department of Thoracic Surgery, Shiraz Universityof Medical Sciences, Shiraz, Iran.
| | - Mohammad Reza Radpey
- Department of Vascular Surgery, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Armin Amirian
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Shahin Khodaei
- Department of General Surgery, Shiraz University of Medical Sciences, Shiraz, Iran.
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Alvarado C, Vargas F, Guzmán F, Zárate A, Correa JL, Ramírez A, Quintero DM, Ramírez EM. Trauma cardiaco cerrado. REVISTA COLOMBIANA DE CARDIOLOGÍA 2016. [DOI: 10.1016/j.rccar.2015.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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de Biasi AR, Seastedt KP, Eachempati SR, Salemi A. Common Cause of Mortality in Trauma but Manageable Nonetheless. Circulation 2015; 132:537-45. [PMID: 26260499 DOI: 10.1161/circulationaha.115.016061] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Andreas R de Biasi
- From Department of Cardiothoracic Surgery, Division of Cardiac Surgery (A.R.d.B., A.S.), and Department of Surgery, Division of Burn, Critical Care, and Trauma Surgery (K.P.S., S.R.E.), Weill Cornell Medical College/New York-Presbyterian Hospital, New York
| | - K Patrick Seastedt
- From Department of Cardiothoracic Surgery, Division of Cardiac Surgery (A.R.d.B., A.S.), and Department of Surgery, Division of Burn, Critical Care, and Trauma Surgery (K.P.S., S.R.E.), Weill Cornell Medical College/New York-Presbyterian Hospital, New York
| | - Soumitra R Eachempati
- From Department of Cardiothoracic Surgery, Division of Cardiac Surgery (A.R.d.B., A.S.), and Department of Surgery, Division of Burn, Critical Care, and Trauma Surgery (K.P.S., S.R.E.), Weill Cornell Medical College/New York-Presbyterian Hospital, New York
| | - Arash Salemi
- From Department of Cardiothoracic Surgery, Division of Cardiac Surgery (A.R.d.B., A.S.), and Department of Surgery, Division of Burn, Critical Care, and Trauma Surgery (K.P.S., S.R.E.), Weill Cornell Medical College/New York-Presbyterian Hospital, New York.
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Özkurtul O, Höch A, Reske A, Hädrich C, Josten C, Böhme J. Severe cardiac trauma or myocardial ischemia? Pitfalls of polytrauma treatment in patients with ST-elevation after blunt chest trauma. Ann Med Surg (Lond) 2015; 4:254-9. [PMID: 26288729 PMCID: PMC4539162 DOI: 10.1016/j.amsu.2015.07.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 07/21/2015] [Accepted: 07/24/2015] [Indexed: 11/15/2022] Open
Abstract
Introduction Thoracic injuries are the third most common injuries in polytrauma patients. The mechanism of injury and the clinical presentation are crucially important for adequate emergency treatment. Presentation of case Here we present a case of a 37-year-old male who was admitted to our level-1 trauma center after motor vehicle accident. The emergency physician on scene presented the patient with a myocardial infarction. During initial clinical trauma assessment the patient developed circulatory insufficiency so that cardiopulmonary resuscitation was necessary. Considering the preclinical and clinical course it was decided to proceed with thrombolysis. Despite consistently sufficient resuscitation measures circulatory function was not restored and the patient remained in asystole and passed away. Discussion The initial assessment showed cardiopulmonary instability. After applying thrombolysis a therapeutic point of no return was reached because surgical intervention was impossible but autopsy findings showed severe myocardial and pulmonary contusions likely due to shear forces. Conclusion This case outlines the importance of understanding the key mechanism of injury and the importance of communication at each stage of healthcare transfer. A transesophageal echocardiography can help to identify injuries after myocardial contusion. ECG changes after blunt chest trauma can be misleading. Only by knowing the cause of accident can avoid erroneous time-intensive diagnostics and ensure a proper overall assessment. A TEE can be a useful early adjunct in trauma management in the setting of ongoing instability because it can guide resuscitation efforts. A stantardized preclinical – trauma room protocol according to ALTS® should be used during transfer. A thromblysis should be avoided in the acute setting because a blunt chest trauma can mimic a myocardial infarction.
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Affiliation(s)
- Orkun Özkurtul
- Department of Trauma, Plastic and Reconstructive Surgery, University of Leipzig, Liebigstr. 20, 04103 Leipzig, Germany
| | - Andreas Höch
- Department of Trauma, Plastic and Reconstructive Surgery, University of Leipzig, Liebigstr. 20, 04103 Leipzig, Germany
| | - Andreas Reske
- Department of Anaesthesiology and Intensive Care Medicine, University of Leipzig, Liebigstr. 20, 04103 Leipzig, Germany
| | - Carsten Hädrich
- Institute of Legal Medicine, University of Leipzig, Faculty of Medicine, Johannisallee 28, 04103 Leipzig, Germany
| | - Christoph Josten
- Department of Trauma, Plastic and Reconstructive Surgery, University of Leipzig, Liebigstr. 20, 04103 Leipzig, Germany
| | - Jörg Böhme
- Department of Trauma, Plastic and Reconstructive Surgery, University of Leipzig, Liebigstr. 20, 04103 Leipzig, Germany
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Hanschen M, Kanz KG, Kirchhoff C, Khalil PN, Wierer M, van Griensven M, Laugwitz KL, Biberthaler P, Lefering R, Huber-Wagner S. Blunt Cardiac Injury in the Severely Injured - A Retrospective Multicentre Study. PLoS One 2015; 10:e0131362. [PMID: 26136126 PMCID: PMC4489656 DOI: 10.1371/journal.pone.0131362] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 06/01/2015] [Indexed: 11/21/2022] Open
Abstract
Background Blunt cardiac injury is a rare trauma entity. Here, we sought to evaluate the relevance and prognostic significance of blunt cardiac injury in severely injured patients. Methods In a retrospective multicentre study, using data collected from 47,580 patients enrolled to TraumaRegister DGU (1993-2009), characteristics of trauma, prehospital / hospital trauma management, and outcome analysis were correlated to the severity of blunt cardiac injury. The severity of cardiac injury was assessed according to the abbreviated injury score (AIS score 1-6), the revised injury severity score (RISC) allowed comparison of expected outcome with injury severity-dependent outcome. N = 1.090 had blunt cardiac trauma (AIS 1-6) (2.3% of patients). Results Predictors of blunt cardiac injury could be identified. Sternal fractures indicate a high risk of the presence of blunt cardiac injury (AIS 0 [control]: 3.0%; AIS 1: 19.3%; AIS 2-6: 19.1%). The overall mortality rate was 13.9%, minor cardiac injury (AIS 1) and severe cardiac injury (AIS 2-6) are associated with higher rates. Severe blunt cardiac injury (AIS 4 and AIS 5-6) is associated with a higher mortality (OR 2.79 and 4.89, respectively) as compared to the predicted average mortality (OR 2.49) of the study collective. Conclusion Multiple injured patients with blunt cardiac trauma are at high risk to be underestimated. Careful evaluation of trauma patients is able to predict the presence of blunt cardiac injury. The severity of blunt cardiac injury needs to be stratified according to the AIS score, as the patients’ outcome is dependent on the severity of cardiac injury.
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Affiliation(s)
- Marc Hanschen
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Karl-Georg Kanz
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Chlodwig Kirchhoff
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Philipe N. Khalil
- Department of General, Visceral-, Transplantation-, Vascular- and Thoracic Surgery—Campus Grosshadern, University Hospital Munich (LMU), Munich, Germany
| | - Matthias Wierer
- Department of General, Visceral-, Transplantation-, Vascular- and Thoracic Surgery—Campus Grosshadern, University Hospital Munich (LMU), Munich, Germany
| | - Martijn van Griensven
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Karl-Ludwig Laugwitz
- I. Medical Department, Cardiology, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Peter Biberthaler
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Rolf Lefering
- IFOM–Institute for Research in Operative Medicine, University Witten/Herdecke, Faculty of Health, Cologne, Germany
| | - Stefan Huber-Wagner
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
- * E-mail:
| | - TraumaRegister DGU
- Committee on Emergency Medicine, Intensive Care and Trauma Management of the German Trauma Society (Sektion NIS), Berlin, Germany
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Skinner DL, Laing GL, Rodseth RN, Ryan L, Hardcastle TC, Muckart DJJ. Blunt cardiac injury in critically ill trauma patients: a single centre experience. Injury 2015; 46:66-70. [PMID: 25264354 DOI: 10.1016/j.injury.2014.08.051] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 08/13/2014] [Accepted: 08/31/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE This study describes the incidence and outcomes of blunt cardiac injury (BCI) in a single trauma intensive care unit (TICU), together with the spectrum of thoracic injuries and cardiac abnormalities seen in BCI. METHODS We performed a retrospective observational study of 169 patients with blunt thoracic trauma admitted from January 2010 to April 2013. BCI was diagnosed using an elevated serum troponin in the presence of either clinical, ECG or transthoracic echocardiography (TTE) abnormalities in keeping with BCI. The mechanism of injury, associated thoracic injuries and TTE findings in these patients are reported. RESULTS The incidence of BCI among patients with blunt thoracic trauma was 50% (n=84). BCI patients had higher injury severity scores (ISS) (median 37 [IQR 29-47]; p=0.001) and higher admission serum lactate levels (median 3.55 [IQR 2.4-6.2], p=0.008). In patients with BCI, the median serum TnI level was 2823ng/L (IQR 1353-6833), with the highest measurement of 64950ng/L. TTEs were performed on 38 (45%) patients with BCI, of whom 30 (79%) had abnormalities. Patients with BCI had a higher mortality (32% vs. 16%; p=0.028) and trended towards a longer length of stay (17.0 days [standard deviation (SD) 13.5] vs. 13.6 days [SD 12.0]; p=0.084). CONCLUSIONS BCI was associated with an increased mortality and a trend towards a longer length of stay in this study. It is a clinically relevant diagnosis which requires a high index of suspicion. Screening of high risk patients with significant blunt thoracic trauma for BCI with serum troponins should be routine practise. Patients diagnosed with BCI should undergo more advanced imaging such as TTE or TOE to exclude significant cardiac structural injury.
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Affiliation(s)
- D L Skinner
- Department of Critical Care, King Edward VIII Hospital, P/Bag X02 Congella 4013, Durban, KwaZulu-Natal 4083, South Africa; Perioperative Research Group, Department of Anaesthetics & Critical Care, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
| | - G L Laing
- Department of Surgery, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - R N Rodseth
- Perioperative Research Group, Department of Anaesthetics & Critical Care, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa; Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA
| | - L Ryan
- Perioperative Research Group, Department of Anaesthetics & Critical Care, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - T C Hardcastle
- Department of Surgery, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa; Level I Trauma Unit and Trauma Intensive Care, Inkosi Albert Luthuli Central Hospital, Durban, South Africa
| | - D J J Muckart
- Department of Surgery, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa; Level I Trauma Unit and Trauma Intensive Care, Inkosi Albert Luthuli Central Hospital, Durban, South Africa
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29
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Using a New Evidence-Based Trauma Protocol to Improve Detection and Reduce Costs in Patients With Blunt Cardiac Injury. J Trauma Nurs 2015; 22:28-34. [DOI: 10.1097/jtn.0000000000000096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Blunt cardiac injury has a wide spectrum of clinical presentations, some of them quite severe. Its definition varies throughout the literature. The purpose of this review is to describe the epidemiology, screening, diagnosis and management of blunt cardiac injury. Blunt cardiac injury complicates up to 30% of severe blunt force trauma. It can be classified into electrical and structural abnormalities. Screening modalities include electrocardiogram and cardiac enzymes. Serial negative electrocardiograms and troponins can safely rule out blunt cardiac injury. A transthoracic echocardiogram should be performed if persistent dysrhythmia or hypotension. All dysrhythmias should be treated. Patients with structural abnormalities rarely survive. In conclusion, blunt cardiac injury is prevalent after significant blunt trauma. The appropriate screening modalities should be employed and any abnormality to be treated.
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Affiliation(s)
- Emilie Joos
- Division of Trauma and Surgical Critical Care, University of Southern California, Los Angeles, CA, USA
| | - Matthew D Tadloc
- Division of Trauma and Surgical Critical Care, University of Southern California, Los Angeles, CA, USA
| | - Kenji Inaba
- Division of Trauma and Surgical Critical Care, University of Southern California, Los Angeles, CA, USA
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Fila P, Piler P, Bedanova H, Nemec P. Successful transplantation of a heart with an atrial septal defect caused by blunt trauma. J Card Surg 2014; 29:430-1. [PMID: 24580536 DOI: 10.1111/jocs.12320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We report a case of a successful heart transplantation from a donor after multiple trauma. A traumatic atrial septal defect was repaired, and the postoperative course was uneventful.
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Affiliation(s)
- Petr Fila
- Centre of Cardiovascular Surgery and Transplantations, Brno, Czech Republic; International Clinical Research Centre, St. Anne's University Hospital, Brno, Czech Republic
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Ryan L, Skinner DL, Rodseth RN. Ventricular septal defect following blunt chest trauma. J Emerg Trauma Shock 2013; 5:184-7. [PMID: 22787351 PMCID: PMC3391845 DOI: 10.4103/0974-2700.96492] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Accepted: 01/18/2012] [Indexed: 11/18/2022] Open
Abstract
We present a 32-year-old male with ventricular septal defect (VSD) following blunt chest trauma. Traumatic VSD is a rare but potentially life-threatening injury, the severity, course and presentation of which are variable. While the diagnosis of myocardial injury may be challenging, cardiac troponins are useful as a screening and diagnostic test. The proposed pathophysiological mechanisms in the development of traumatic VSD are early mechanical rupture and delayed inflammatory rupture. We conducted a literature review to investigate the pathogenesis, distribution of patterns of presentation, and the associated prognoses in patients with VSD following blunt chest trauma. We found that traumatic VSDs diagnosed within 48 hours were more likely to be severe, require emergency surgery and were associated with a higher mortality. Children with traumatic VSDs had an increased mortality risk. Smaller lesions may be managed conservatively but should be followed up to detect late complications. In both groups elective repair was associated with a good outcome.
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Affiliation(s)
- Lisa Ryan
- Department of Anaesthetics, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
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33
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Fariña Ruiz AP, Medina Darias E, García Franco CE, Rodríguez Esteban M. Contusión miocárdica y derrame pericárdico tras traumatismo esternal cerrado asintomático. Cir Esp 2013; 91:205-6. [DOI: 10.1016/j.ciresp.2012.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Accepted: 10/16/2012] [Indexed: 11/25/2022]
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Huang L, Bakker N, Kim J, Marston J, Grosse I, Tis J, Cullinane D. A Multi-Scale Finite Element Model of Bruising in Soft Connective Tissues. ACTA ACUST UNITED AC 2012. [DOI: 10.4303/jfb/235579] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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35
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Kunz SN, Arborelius UP, Gryth D, Sonden A, Gustavsson J, Wangyal T, Svensson L, Rocksén D. Cardiac changes after simulated behind armor blunt trauma or impact of nonlethal kinetic projectile ammunition. THE JOURNAL OF TRAUMA 2011; 71:1134-1143. [PMID: 22071920 DOI: 10.1097/ta.0b013e318232b079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Cardiac-related injuries caused by blunt chest trauma remain a severe problem. The aim of this study was to investigate pathophysiological changes in the heart that might arise after behind armor blunt trauma or impacts of nonlethal projectiles. METHODS Sixteen pigs were shot directly at the sternum with "Sponge Round eXact I Mpact" (nonlethal ammunition; diameter 40 mm and weight 28 g) or hard-plastic ammunition (diameter 65 mm and weight 58 g) to simulate behind armor blunt trauma. To evaluate the influence of the shot location, seven additional pigs where exposed to an oblique heart shot. Physiologic parameters, electrocardiography, echocardiogram, the biochemical marker troponin I (TnI), and myocardial injuries were analyzed. RESULTS Nonlethal kinetic projectiles (101-108 m/s; 143-163 J) did not cause significant pathophysiological changes. Five of 18 pigs shot with 65-mm plastic projectiles (99-133 m/s; 284-513 J) to the front or side of the thorax died directly after the shot. No major physiologic changes could be observed in surviving animals. Animals shot with an oblique heart shot (99-106 m/s; 284-326 J) demonstrated a small, but significant decrease in saturation. Energy levels over 300 J caused increased TnI and myocardial damages in most of the pigs. CONCLUSION This study indicates that nonlethal kinetic projectiles "eXact iMpact" does not cause heart-related damage under the examined conditions. On impact, sudden heart arrest may occur independently from the cardiac's electrical cycle. The cardiac enzyme, TnI, can be used as a reliable diagnostic marker to detect heart tissue damages after blunt chest trauma.
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Affiliation(s)
- Sebastian N Kunz
- Department of Forensic Medicine, Ludwig-Maximilians University Munich, Germany.
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Weber SU, Hammerstingl C, Mellert F, Baumgarten G, Putensen C, Knuefermann P. [Traumatic tricuspid valve insufficiency with right-to-left shunt: bridging using extracorporeal venovenous membrane oxygenation]. Anaesthesist 2011; 61:41-6. [PMID: 21901648 DOI: 10.1007/s00101-011-1934-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Revised: 06/14/2011] [Accepted: 07/22/2011] [Indexed: 11/25/2022]
Abstract
The case of a young male motor vehicle driver is reported who suffered multiple trauma in a car accident with pulmonary and cardiac contusions. In the course of severe pneumonia and traumatic tricuspid valve insufficiency a right-to-left shunt with refractory hypoxemia developed across a pre-existing atrial septal defect (ASD). The patient could be successfully treated by the combination of extracorporeal membrane oxygenation for bridging, interventional ASD occlusion and in the long-term by operative reconstruction of the tricuspid valve.
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Affiliation(s)
- S U Weber
- Klinik und Poliklinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Deutschland
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37
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Butler N, Mundy J, Shah P. Aortic Complications of Giant Cell Arteritis: A Diagnostic and Management Dilemma. J Card Surg 2010; 25:572-81. [DOI: 10.1111/j.1540-8191.2010.01100.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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McCunn M, Gordon EKB, Scott TH. Anesthetic concerns in trauma victims requiring operative intervention: the patient too sick to anesthetize. Anesthesiol Clin 2010; 28:97-116. [PMID: 20400043 DOI: 10.1016/j.anclin.2010.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Trauma is the third leading cause of death in the U.S. Timely acute care anesthetic management of patients following traumatic injury may improve outcome. Recognition of highly-mortal injuries to the brain, heart, lungs, liver, and pelvis should guide trauma-specific management strategies. Rapid intraoperative treatment of life-threatening conditions following injury includes the use of 'controlled-under resuscitation' of fluid administration until surgical hemorrhage control, early factor replacement in addition to transfusion of packed red blood cells, and use of adjuvant therapies such as recombinant factor VIIa. These treatment strategies, other recent developments in acute trauma resuscitation, and a review of associated co-existing medical conditions that may impact mortality, are presented.
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Affiliation(s)
- Maureen McCunn
- Department of Anesthesiology and Critical Care, University of Pennsylvania School of Medicine, Dulles 6, 3400 Spruce Street, Philadelphia, PA 19104, USA.
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Letters to the Editor. Am Surg 2009. [DOI: 10.1177/000313480907500610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Khurana S, Puri R, Wong D, Dundon BK, Brown MA, Worthley MI, Worthley SG. Latent tricuspid valve rupture after motor vehicle accident and routine echocardiography in all chest-wall traumas. Tex Heart Inst J 2009; 36:615-617. [PMID: 20069094 PMCID: PMC2801947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Blunt chest-wall trauma is common; however, resultant tricuspid valve rupture is rare and can be subtle in its presentation. Transthoracic echocardiography plays a key role in diagnosis. Herein, we report the case of a 42-year-old woman who sustained substantial chest-wall trauma in a high-speed motor vehicle accident. She presented a week later with symptoms of right-heart failure, secondary to flail tricuspid valve leaflets and torrential tricuspid regurgitation. The case of this patient highlights the importance of early diagnosis and elicits discussion of the mechanisms that can underlie delayed tricuspid valve rupture. Because the clinical diagnosis of tricuspid valve rupture can be difficult, we believe that echocardiography should be used early and, if necessary, repeatedly in all patients who sustain blunt chest-wall trauma.
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Affiliation(s)
- Suchi Khurana
- Cardiovascular Investigations Unit, Royal Adelaide Hospital, Adelaide 5000, SA, Australia.
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Konijn AJM, Egbers PHM, Kuiper MA. Pneumopericardium should be considered with electrocardiogram changes after blunt chest trauma: a case report. J Med Case Rep 2008; 2:100. [PMID: 18394149 PMCID: PMC2323010 DOI: 10.1186/1752-1947-2-100] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2007] [Accepted: 04/04/2008] [Indexed: 12/03/2022] Open
Abstract
Introduction Electrocardiogram (ECG) abnormalities in patients with blunt chest trauma are diverse and non-specific, but may be indicative of potentially life-threatening conditions. Case presentation We report a rare case of pneumopericardium with extreme ECG abnormalities after blunt chest trauma in a 22-year-old male. The diagnosis was confirmed using computed tomography (CT) scanning. The case is discussed, together with its differential diagnosis and the aetiology of pneumopericardium and tension pneumopericardium. Conclusion Pneumopericardium should be distinguished from other pathologies such as myocardial contusion and myocardial infarction because of the possible development of tension pneumopericardium. Early CT scanning is important in the evaluation of blunt chest trauma.
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Affiliation(s)
- Arjan J M Konijn
- Department of Intensive Care, Medical Centre Leeuwarden, 8901 BR, Leeuwarden, The Netherlands.
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Advanced Trauma Life Support (ATLS) and facial trauma: can one size fit all? Int J Oral Maxillofac Surg 2008; 37:209-14. [DOI: 10.1016/j.ijom.2007.11.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2007] [Revised: 07/29/2007] [Accepted: 11/06/2007] [Indexed: 11/17/2022]
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Grozieux de Laguérenne N, Pretorian EM, Jaboureck O, Leroy F, Joly P, Dujardin JJ. [A case of chest trauma-induced acute myocardial infarction]. Ann Cardiol Angeiol (Paris) 2007; 56:211-215. [PMID: 17920557 DOI: 10.1016/j.ancard.2007.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2007] [Accepted: 08/30/2007] [Indexed: 05/25/2023]
Abstract
The occurrence of an acute myocardial infarction (MI) after chest trauma is a rare complication. We report a case of a 58-year-old man presenting with an acute anterolateral MI secondary to blunt chest trauma. Coronary angiography revealed a non significant lesion of a first diagonal branch without any atherosclerosis lesion on coronary artery. He was conservatively managed and resulted in a good prognosis. Based on this case, we discuss the path physiologic mechanism of MI following chest trauma.
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Southam S, Jutila C, Ketai L. Contrast-enhanced Cardiac MRI in Blunt Chest Trauma: Differentiating Cardiac Contusion from Acute Peri-traumatic Myocardial Infarction. J Thorac Imaging 2006; 21:176-8. [PMID: 16770235 DOI: 10.1097/00005382-200605000-00010] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Blunt cardiac trauma most commonly manifests as a myocardial contusion. These contusions can cause cardiac enzyme leaks, electrocardiographic abnormalities, and cardiac contractile dysfunction making it difficult to differentiate a myocardial contusion from a peri-traumatic myocardial infarction. We present a case in which delayed contrast-enhanced cardiac magnetic resonance imaging was used to differentiate between contusion and myocardial infarction, leading to conservative management with subsequent complete restitution of myocardial function.
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Affiliation(s)
- Sam Southam
- Department of Radiology, University of New Mexico HSC, Albuquerque, NM 87131-0001, USA
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