Difference between revisions of "Cardiac injury"

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==Background==
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*[[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>
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*[[Penetrating cardiac injury]]
 
 
==Clinical Features==
 
===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 tamponade]]
 
**Most often results from stab wounds; up to 80% of myocardial stab wounds may develop cardiac tamponade
 
**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>
 
*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
 
*[[Commotio Cordis]]
 
**Primary electrical event resulting in the induction of Vfib
 
**Often an innocent-appearing blow to chest wall
 
 
 
==Differential Diagnosis==
 
{{Thoracic trauma DDX}}
 
 
 
==Evaluation==
 
*[[CXR]]
 
**Mediastinum widening is only suggestive of an aortic injury
 
***Lack of widening does not rule out aortic injury
 
*CTA
 
**Imaging study of choice for penetrating and blunt trauma
 
*[[FAST exam]]
 
**First view of FAST in penetrating injury should be pericardial
 
**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 patients
 
**Combination of normal ECG and normal troponin 100% sn in one study
 
 
 
==Management==
 
===Penetrating Trauma===
 
*[[Thoracotomy]]
 
*[[Pericardiocentesis]]
 
===Blunt Trauma===
 
*Observe all patients with 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 patients die at the scene
 
*Control of BP and HR is important if operative management will be delayed
 
 
 
===Subclavian===
 
*Usually due to direct trauma or fracture of first rib or clavicle
 
*Loose shoulder restraint
 
===IVC/SVC===
 
*Suspect if major hepatic injury or patient has bleeding that cannot be identified
 
 
 
==See Also==
 
*[[Thoracic Trauma]]
 
*[[Commotio Cordis]]
 
 
 
==References==
 
<references/>
 
  
 
[[Category:Trauma]]
 
[[Category:Trauma]]
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[[Category:Cardiology]]

Latest revision as of 19:56, 17 August 2019