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| ==Background==
| | *[[Blunt cardiac injury]] |
| *Spectrum of disease due to blunt trauma to the chest wall - ranges from mild contusion to cardiac rupture and death.<ref name="El-Menyar">El-Menyar A, Al Thani H, Zarour A, Latifi R. Understanding traumatic blunt cardiac injury. Ann Card Anaesth. 2012 Oct-Dec;15(4):287-95. doi: 10.4103/0971-9784.101875.</ref>
| | *[[Penetrating cardiac injury]] |
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| ==Clinical Presentation==
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| ===Penetrating Trauma===
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| *Location
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| **Stab wounds
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| ***Usually affect heart if enter via the "cardiac box"
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| ****Chest area bounded by sternal notch, xiphoid, and nipple
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| **GSW can affect heart even if enters at distant site
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| *Ventricles are at greatest risk due to anterior location
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| **RV (involved in 40% of injuries)
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| **LV (involved in 35% of injuries)
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| **RA (involved in 20% of injuries)
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| **LA (involved in 5% of injuries)
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| *[[Cardiac tamponade]] | |
| **Most often results from stab wounds; up to 80% of myocardial stab wounds may develop cardiac tamponade
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| **GSW less likely to develop into tamponade because it is more difficult for the pericardium to seal the defect (larger, more irregular in shape) <ref>Tintinalli's</ref>
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| *Cardiac missiles
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| **Those that cause BP instability, free or partially exposed should be removed
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| **Most intramyocardial and intrapericadrial bullets can be left in place
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| ===Blunt Trauma===
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| *Up to 20% of all MVC deaths are due to blunt cardiac injury
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| *Most often involves the right heart (due to ant location)
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| **Injury to valves occurs in 10%
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| *May present as:
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| **MI (coronary artery injury)
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| **Acute heart failure (valve rupture)
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| **Dysrhythmias
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| *[[Commotio Cordis]]
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| **Primary electrical event resulting in the induction of Vfib
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| **Often an innocent-appearing blow to chest wall
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| ==Differential Diagnosis==
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| {{Thoracic trauma DDX}}
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| ==Diagnosis==
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| *CXR
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| **Mediastinum widening is only suggestive of an aortic injury
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| ***Lack of widening does not rule out aortic injury
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| *CTA
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| **Imaging study of choice for penetrating and blunt trauma
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| *[[Ultrasound: FAST]] | |
| **First view of FAST in penetrating injury should be pericardial
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| **Pericardial fluid detection (Sn 100%, Sp 97%)
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| *ECG
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| **NPV for a normal ECG is 80-90%
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| **Not as sensitive for right-sided injuries
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| *Troponin
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| **Trend in all patients
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| **Combination of normal ECG and normal troponin 100% sn in one study
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| ==Management==
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| ===Penetrating Trauma===
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| *[[Thoracotomy]]
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| *[[Pericardiocentesis]]
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| ===Blunt Trauma===
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| *Observe all patients w/ cont cardiac monitoring and interval assessment of cardiac markers
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| ==Great Vessels Injury==
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| ===Aorta===
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| *Proximal descending aorta is most commonly injured in blunt trauma
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| **Due to fixation of vessels between L subclavian artery and ligamentum arteriosum
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| *Most patients die at the scene
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| *Control of BP and HR is important if operative management will be delayed
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| ===Subclavian===
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| *Usually due to direct trauma or fx of first rib or clavicle
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| *Loose shoulder restraint
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| ===IVC/SVC===
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| *Suspect if major hepatic injury or patient has bleeding that cannot be identified
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| ==See Also==
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| *[[Thoracic Trauma]]
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| *[[Commotio Cordis]]
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| ==References==
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| <references/>
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| [[Category:Trauma]] | | [[Category:Trauma]] |
| | [[Category:Cardiology]] |
