Cardiac injury

Background

Penetrating Trauma

• Location
  • Stab wounds
    • Usually affect heart if enter via the "cardiac box"
      • Chest area bounded by sternal notch, xiphoid, and nipple
  • GSW can affect heart even if enters at distant site
• Ventricles are at greatest risk due to anterior location
  • RV (involved in 40% of injuries)
  • LV (involved in 35% of injuries)
  • RA (involved in 20% of injuries)
  • LA (involved in 5% of injuries)
• Cardiac missiles
  • Those that cause BP instability, free or partially exposed should be removed
  • Most intramyocardial and intrapericadrial bullets can be left in place

Blunt Trauma

• Up to 20% of all MVC deaths are due to blunt cardiac injury
• Most often involves the right heart (due to ant location)
  • Injury to valves occurs in 10%
• May present as:
  • MI (coronary artery injury)
  • Acute heart failure (valve rupture)
  • Dysrhythmias

Workup

• FAST
  • Pericardial fluid detection (Sn 100%, Sp 97%)
• ECG
  • NPV for a normal ECG is 80-90%
  • Not as sensitive for right-sided injuries
• Troponin
  • Trend in all pts
  • Combination of normal ECG and normal troponin 100% sn in one study

Management

Penetrating Trauma

• Procedures
  • Thoracotomy
  • Pericardiocentesis

Blunt Trauma

• Observe all pts w/ cont cardiac monitoring and interval assessment of cardiac markers

Great Vessels Injury

• Aorta
  • Proximal descending aorta is most commonly injured in blunt trauma
    • Due to fixation of vessels between L subclavian artery and ligamentum arteriosum
  • Most pts die at the scene
• Subclavian
  • Usually due to direct trauma or fx of first rib or clavicle
  • Loose shoulder restraint
• IVC/SVC
  • Suspect if major hepatic injury or bleeding that cannot be identified

Diagnosis

• CXR
  • Mediastinum widening

See Also

Commotio Cordis