Cardiac injury

Revision as of 05:52, 18 July 2011 by Jswartz (talk | contribs) (Created page with "==Background== ===Penetrating Trauma=== *Location **Stab wounds ***Usually affect heart if enter via the "cardiac box" ****Chest area bounded by sternal notch, xiphoid, and nippl...")
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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

Treatment


Disposition

See Also

Commotio Cordis


Source