Difference between revisions of "Cardiac injury"

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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>
*[[Penetrating cardiac injury]]
==Clinical Features==
===Penetrating Trauma===
**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)
*[[Commotio Cordis]]
**Primary electrical event resulting in the induction of Vfib
**Often an innocent-appearing blow to chest wall
==Differential Diagnosis==
{{Thoracic trauma DDX}}
**Mediastinum widening is only suggestive of an aortic injury
***Lack of widening does not rule out aortic injury
**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%)
**NPV for a normal ECG is 80-90%
**Not as sensitive for right-sided injuries
**Trend in all patients
**Combination of normal ECG and normal troponin 100% sn in one study
===Penetrating Trauma===
===Blunt Trauma===
*Observe all patients with cont cardiac monitoring and interval assessment of cardiac markers
==Great Vessels Injury==
*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
*Usually due to direct trauma or fracture of first rib or clavicle
*Loose shoulder restraint
*Suspect if major hepatic injury or patient has bleeding that cannot be identified
==See Also==
*[[Thoracic Trauma]]
*[[Commotio Cordis]]

Latest revision as of 19:56, 17 August 2019