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Journal of the American College of... Mar 2023Causes and precipitating factors of sudden cardiac death (SCD) in adolescents are poorly understood.
BACKGROUND
Causes and precipitating factors of sudden cardiac death (SCD) in adolescents are poorly understood.
OBJECTIVES
The authors sought to investigate the etiologies of SCD and their association with physical activity in a large cohort of adolescents.
METHODS
Between 1994 and June 2022, 7,675 cases of SCD were consecutively referred to our national cardiac pathology center; 756 (10%) were adolescents. All cases underwent detailed autopsy evaluation by expert cardiac pathologists. Clinical information was obtained from referring coroners.
RESULTS
A structurally normal heart, indicative of sudden arrhythmic death syndrome was the most common autopsy finding (n = 474; 63%). Myocardial diseases were detected in 163 cases (22%), including arrhythmogenic cardiomyopathy (n = 36; 5%), hypertrophic cardiomyopathy (n = 31; 4%), idiopathic left ventricular hypertrophy (n = 31; 4%), and myocarditis (n = 30; 4%). Coronary artery anomalies were identified in 17 cases (2%). Decedents were competitive athletes in 128 cases (17%), and 159 decedents (21%) died during exercise. Arrhythmogenic cardiomyopathy was diagnosed in 8% of athletes compared with 4% of nonathletes (P = 0.05); coronary artery anomalies were significantly more common in athletes (9% vs 1%; P < 0.001), as well as commotio cordis (5% compared with 1% in nonathletes; P = 0.001). The 3 main comorbidities were asthma (n = 58; 8%), epilepsy (n = 44; 6%), and obesity (n = 40; 5%).
CONCLUSIONS
Sudden arrhythmic death syndrome and myocardial diseases are the most common conditions diagnosed at autopsy in adolescent victims of SCD. Among causes of SCD, arrhythmogenic cardiomyopathy, coronary artery anomalies, and commotio cordis are more common in young athletes than in similar age sedentary individuals.
Topics: Humans; Adolescent; Commotio Cordis; Death, Sudden, Cardiac; Athletes; Cardiomyopathies; United Kingdom; Coronary Artery Disease
PubMed: 36922085
DOI: 10.1016/j.jacc.2023.01.041 -
Arrhythmia & Electrophysiology Review Aug 2017Lightning strikes are a common and leading cause of morbidity and mortality. Multiple organ systems can be involved, though the effects of the electrical current on the...
Lightning strikes are a common and leading cause of morbidity and mortality. Multiple organ systems can be involved, though the effects of the electrical current on the cardiovascular system are one of the main modes leading to cardiorespiratory arrest in these patients. Cardiac effects of lightning strikes can be transient or persistent, and include benign or life-threatening arrhythmias, inappropriate therapies from cardiac implantable electronic devices, cardiac ischaemia, myocardial contusion, pericardial disease, aortic injury, as well as cardiomyopathy with associated ventricular failure. Prolonged resuscitation can lead to favourable outcomes especially in young and previously healthy victims.
PubMed: 29018518
DOI: 10.15420/aer.2017:7:3 -
Journal of Cardiothoracic Surgery Mar 2022Traumatic asphyxia (TA) is a rarely reported disease characterized as thoraco-cervico-facial petechiae, facial edema and cyanosis, subconjunctival hemorrhage and...
BACKGROUND
Traumatic asphyxia (TA) is a rarely reported disease characterized as thoraco-cervico-facial petechiae, facial edema and cyanosis, subconjunctival hemorrhage and neurological symptoms. This study aimed to report 51 children of TA at the pediatric medical center of west China.
METHODS
Scanned medical reports were reviewed and specific variables as age, sex, cause of injury, clinical manifestations and associated injuries were analyzed using SPSS 25.0.
RESULTS
The average age of patients was 5.3 ± 2.9 (1.3-13.2) year-old. Thirty (58.8%) were boys and 21 (41.2%) were girls. Most TAs occurred during vehicle accident, object compression and stampede. All patients showed facial petechiae (100.0%, CI 93.0-100.0%), 25 (49.0%, CI 34.8-63.2%) out of 51 presented with facial edema, 29 (56.9%, CI 42.8-70.9%) presented with subconjunctival hemorrhage, including bilateral 27 and unilateral 2. Six patients had facial cyanosis (11.8%, CI 2.6-20.9%). Other symptoms were also presented as epileptic seizure, vomiting, incontinence, paraplegia, etc. The most frequent companion injury was pulmonary contusion (76.5%, CI 64.4-88.5%). Other companion injuries included mediastinal emphysema, fracture, cerebral contusion and hemorrhage, hypoxic-ischemic brain injury, abdominal organ contusion, mastoid hemorrhage, hematocele of paranasal sinuses, spinal cord injury, hepatic insufficiency, myocardial injury and retinal hemorrhage and edema. Treatment was mainly supportive. No death occurred in our study. The prognosis is rather good if without damage of central nervous system.
CONCLUSION
TA could bring out multiple symptoms, among which retinal hemorrhage and edema, spinal cord injury and viscera impairment have been less observed. Comprehensive physical and auxiliary examination should be performed considering TA. Its prognosis is rather good with focus on life-threatening complications.
Topics: Adolescent; Asphyxia; Child; Child, Preschool; Female; Hemorrhage; Humans; Infant; Male; Prognosis; Retrospective Studies; Spinal Cord Injuries
PubMed: 35282839
DOI: 10.1186/s13019-022-01773-2 -
BMJ Case Reports Mar 2016Early bystander cardiopulmonary resuscitation and rapid defibrillation are the most important factors for favourable outcomes after out of hospital cardiac arrest...
Early bystander cardiopulmonary resuscitation and rapid defibrillation are the most important factors for favourable outcomes after out of hospital cardiac arrest (OHCA)-as the new American Heart Association/European Resuscitation Council (AHA/ERC) guidelines emphasise. The patient in our case was a healthy young man who had a witnessed cardiac arrest due to a chest collision with the goalkeeper during a football match. Basic life support was immediately provided by his teammates until an automated external defibrillator was brought to the scene. Blunt cardiac injury (BCI) may result in injured myocardium or arrhythmias. Ventricular fibrillation due to BCI in absence of structural cardiac disease is one of the main causes of OHCA in young healthy athletes with high mortality rates. We demonstrate important aspects of the recently released guidelines on cardiac arrest and the chain of survival by the leading societies.
Topics: Cardiopulmonary Resuscitation; Heart; Humans; Male; Myocardial Contusions; Out-of-Hospital Cardiac Arrest; Treatment Outcome; Ventricular Fibrillation; Young Adult
PubMed: 26968838
DOI: 10.1136/bcr-2016-214382 -
Surgical Case Reports May 2022Cardiac injury, including myocardial contusion and valvular damage, is a common complication of blunt chest trauma; however, traumatic ventricular septal rupture is a...
Cardiac injury, including myocardial contusion and valvular damage, is a common complication of blunt chest trauma; however, traumatic ventricular septal rupture is a rare complication. We encountered a rare case of ventricular septal rupture following blunt chest trauma that was successfully repaired by emergency surgery. The mechanism underlying rupture may involve acute compression of the heart between the sternum and the vertebral column when the ventricle is filled, thereby causing a sudden increase in intraventricular pressure and leading to septal rupture. Emergency operation should be considered in cases of large defects and hemodynamic instability.
PubMed: 35553269
DOI: 10.1186/s40792-022-01448-z -
Ulusal Travma Ve Acil Cerrahi Dergisi =... Mar 2023This study aimed to examine whether two different doses of dexamethasone (DXM), which is a corticosteroid, and amifostine (AMI), which reduces cumulative tissue toxicity...
BACKGROUND
This study aimed to examine whether two different doses of dexamethasone (DXM), which is a corticosteroid, and amifostine (AMI), which reduces cumulative tissue toxicity induced by cisplatin in advanced-stage cancer patients, have ameliorative effects on pathologic changes associated with cardiac contusion (CC) induced in rats.
METHODS
Forty-two Wistar albino rats were equally divided into six groups (n=7): C, CC, CC+AMI 400, CC+AMI 200, CC+AMI+DXM, and CC+DXM. Tomography images and electrocardiographic analyzes were performed, mean arterial pressure was measured from the carotid artery, and blood and tissue samples were obtained for histopathological and biochemical analyses after trauma-induced CC.
RESULTS
While the total oxidant status and disulfide parameters in the cardiac tissue and serum were significantly higher (p<0.05), the total antioxidant status, total thiol, and native thiol parameters were significantly lower (p<0.01) in rats with trauma-induced CC. The most frequently observed finding in the electrocardiography analyze was ST elevation.
CONCLUSION
According to evaluation based on histological, biochemical, and electrocardiographic examinations, we believe that only 400 mg/kg dose of AMI or DXM can be effective in the treatment of myocardial contusion in rats. Evaluation based on histological findings.
Topics: Rats; Animals; Rats, Wistar; Thoracic Injuries; Amifostine; Wounds, Nonpenetrating; Heart Injuries; Myocardial Contusions
PubMed: 36880625
DOI: 10.14744/tjtes.2023.84308 -
Ulusal Travma Ve Acil Cerrahi Dergisi =... Aug 2022Acute cardiac contusion induced by trauma is known with its high mortality and morbidity. The role of oxidative stress and inflammation in its pathophysiology has led to...
BACKGROUND
Acute cardiac contusion induced by trauma is known with its high mortality and morbidity. The role of oxidative stress and inflammation in its pathophysiology has led to the investigation of antioxidant and anti-inflammatory substances in non-sur-gical treatment. In this study, the effects of rutin which has these two features on acute cardiac contusion were investigated.
METHODS
Thirty male albino Wistar rats were divided into three equal groups as healthy (HG), contusion (CG), and rutin + con-tusion (rutin + CG). A heart contusion was created dropping 200 g weight from 1-m height onto anterior thorax of CG (n=10) and Rutin + CG (n=10) group animals by anesthetizing with intraperitoneal administration of 60 mg/kg ketamine and xylazine inhalation at appropriate intervals. Thirty minutes after contusion was applied, rutin at the dose of 50 mg/kg was administered orally to the stomach by gavage to the rutin + CG group animals. The rutin was used once a day for 2 days. Rats were killed at the end of 48 h. Heart tissues were removed and examined biochemically and histopathologically. Troponin I (TP I) and creatine kinase-MB (CK-MB) were measured in blood samples taken from the tail veins just before the rats were killed.
RESULTS
TP I, CK-MB, malondialdehyde, total oxidant status, and nuclear factor-kappa B levels increased in the CG when compared to the HG, and Rutin application prevented this increase, total glutathione (eGSH) and total antioxidant status levels decreased, and rutin application prevented this decrease. Histopathological findings also supported these findings.
CONCLUSION
Rutin had a protective effect on heart tissue.
Topics: Animals; Antioxidants; Contusions; Male; Myocardial Contusions; Oxidative Stress; Rats; Rats, Wistar; Rutin
PubMed: 35920429
DOI: 10.14744/tjtes.2021.97760 -
BioResearch Open Access 2017Our review of real-time three-dimensional echocardiography (RT3DE) discusses the diagnostic utility of RT3DE and provides a comparison with two-dimensional... (Review)
Review
Our review of real-time three-dimensional echocardiography (RT3DE) discusses the diagnostic utility of RT3DE and provides a comparison with two-dimensional echocardiography (2DE) in clinical cardiology. A Pubmed literature search on RT3DE was performed using the following key words: transthoracic, two-dimensional, three-dimensional, real-time, and left ventricular (LV) function. Articles included perspective clinical studies and meta-analyses in the English language, and focused on the role of RT3DE in human subjects. Application of RT3DE includes analysis of the pericardium, right ventricular (RV) and LV cavities, wall motion, valvular disease, great vessels, congenital anomalies, and traumatic injury, such as myocardial contusion. RT3DE, through a transthoracic echocardiography (TTE), allows for increasingly accurate volume and valve motion assessment, estimated LV ejection fraction, and volume measurements. Chamber motion and LV mass approximation have been more accurately evaluated by RT3DE by improved inclusion of the third dimension and quantification of volumetric movement. Moreover, RT3DE was shown to have no statistical significance when comparing the ejection fractions of RT3DE to cardiac magnetic resonance (CMR). Analysis of RT3DE data sets of the LV endocardial exterior allows for the volume to be directly quantified for specific phases of the cardiac cycle, ranging from end systole to end diastole, eliminating error from wall motion abnormalities and asymmetrical left ventricles. RT3DE through TTE measures cardiac function with superior diagnostic accuracy in predicting LV mass, systolic function, along with LV and RV volume when compared with 2DE with comparable results to CMR.
PubMed: 28303211
DOI: 10.1089/biores.2016.0033 -
Trauma Surgery & Acute Care Open 2018A 53-year-old man was admitted to our trauma center after sustaining thoracoabdominal injuries, secondary to a rear-end motor vehicle collision. As he stepped out of his...
UNLABELLED
A 53-year-old man was admitted to our trauma center after sustaining thoracoabdominal injuries, secondary to a rear-end motor vehicle collision. As he stepped out of his vehicle, he was struck by a tractor trailer at 55 mph. The following were the initial vital signs on his arrival: heart rate 140 beats/min, blood pressure 142/80 mm Hg, respiratory rate 28 breaths/min, temperature 36.8°C, and oxygen saturation 93%. The Glasgow Coma Scale score was 15 and the Injury Severity Score was 59. He was evaluated and resuscitated per the advanced trauma life support protocols. The focused assessment with sonography for trauma examination was negative. Initial findings included bilateral chest wall and thoracic spine tenderness, subcutaneous emphysema in the chest and neck, and an unstable pelvis. He required bilateral chest tubes and a pelvic binder. CT imaging revealed a left temporal epidural hematoma, multiple facial fractures, a sternal fracture, a left scapula fracture, acromioclavicular fractures, bilateral hemopneumothoraces, pulmonary contusions, extensive pneumomediastinum compressing the right atrium, multiple rib fractures (2-10 on the left with a flail segment and 2-8 on the right) (figure 1), an unstable open-book pelvic fracture which included bilateral superior and inferior pubic rami fractures, sacral and left iliac wing fractures, and symphysis pubis diastasis.Figure 1Three-dimensional CT scan reconstruction demonstrating left-sided flail chest.The patient developed hypotension and severe respiratory distress, and was intubated. ECG revealed no dysrhythmias. Echocardiogram revealed significant left ventricular wall dysfunction consistent with myocardial contusion and right atrial compression. His troponins were also significantly elevated. He required significant resuscitation with crystalloids, blood products and vasopressors. He underwent bronchoscopy, esophagram and upper endoscopy to exclude tracheoesophageal injury, and these were negative. On hospital day 2, the patient was hemodynamically stable, and pressors were discontinued. His pelvic fractures were repaired using external fixation and sacral screws. Given his extensive left flail chest, he underwent reconstruction of his left chest wall on hospital day 5. Open reduction and internal fixation of his left ribs, 3 to 6 anteriorly and 4 to 7 posteriorly, with titanium plates was performed (figure 2). He had an epidural catheter inserted for analgesia. On postoperative day 2 after chest wall reconstruction, the patient was extubated and resumed enteral feeds. Overnight, the output from the left-sided chest tube changed from serosanguinous to milky. A sample was sent for triglycerides and lymphocyte counts confirming the diagnosis of chylothorax. His chest tube output increased to approximately 2000 mL/day. A lymphangiogram was performed with Lipiodol to diagnose the location of the chylous leak. It revealed contrast extravasation at the level of T3 to T4. An MRI was also performed to better define the anatomic course of the thoracic duct.Figure 2Postoperative chest X-ray demonstrating left chest wall reconstruction.
WHAT WOULD YOU DO?
Conservative management: placing the patient nulla per os (NPO), and starting total parenteral nutrition (TPN), octreotide and midodrine.Thoracic duct embolization by interventional radiology.CT-guided thoracic duct disruption.Thoracotomy with thoracic duct ligation.
PubMed: 30023436
DOI: 10.1136/tsaco-2018-000183 -
Journal of Clinical and Diagnostic... Jun 2017Myocardial contusion is an entity in chest trauma which is difficult to diagnose. Current practice relies more on cardiac-specific biochemical markers and standard...
INTRODUCTION
Myocardial contusion is an entity in chest trauma which is difficult to diagnose. Current practice relies more on cardiac-specific biochemical markers and standard echocardiography, but no gold standard test exists. The application of Tissue Doppler imaging is yet unexplored.
AIM
The present study was designed to evaluate cardiac injury in patients with blunt trauma chest using conventional trans-thoracic echocardiography parameters and Tissue Doppler imaging.
MATERIALS AND METHODS
After ethical approval was taken from the Hospital and University and a written informed consent from all patients/attendants, this prospective study was conducted on a total of 30 patients in range of 15-60 years of age with blunt trauma chest. Patients with positive Trop-T and raised CPK (> 308 IU/L), raised CK-MB (> 24 IU/L) levels were suspected to have myocardial injury and were enrolled in the study. All patients fulfilling the inclusion criteria then underwent 2D-Echo and Tissue Doppler Imaging. Results of the observations were analysed using chi-square test.
RESULTS
Out of the total of 30 patients, 63.3% showed ECG changes suggestive of cardiac injury. A 76.7% patients suffered systolic dysfunction and 36.6% patients suffered diastolic dysfunction irrespective of ECG changes. On comparison of early filling velocity wave i.e., E wave (measured by transthoracic echocardiography) and tricuspid annular velocity Em wave (measured by tissue Doppler echocardiography) at tricuspid valve, we found statistically significant difference among two techniques. (p = 0.04).
CONCLUSION
Echocardiography is very sensitive parameter for evaluation of myocardial contusion. Tissue Doppler imaging provides additional and reliable information.
PubMed: 28764222
DOI: 10.7860/JCDR/2017/22746.10069