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The Kurume Medical Journal Apr 2023Myocardial contusion is the most common cardiac injury from blunt chest trauma (BCT), whereas isolated valve injury is uncommon. We report a case of acute mitral...
Myocardial contusion is the most common cardiac injury from blunt chest trauma (BCT), whereas isolated valve injury is uncommon. We report a case of acute mitral regurgitation (MR) due to isolated valve injury after BCT. A 60-year-old man received an impact on his left chest by a car wheel three weeks prior to visiting our hospital. At the time a diagnosis of contusion of the chest wall without rib and sternal fractures was made. Thereafter, the patient had progressive worsening of heart failure symptoms. Eventually he developed dyspnea on slight exertion but echocardiographic evaluation was not performed at the time of diagnosis or during the three weeks prior to admission. At admission a holosystolic murmur was heard. Transthoracic echocardiography revealed prolapse of the posterior mitral leaflet due to torn chordae tendineae with severe MR and normal left ventricular wall motion. At surgery, torn chordae tendineae and a leaflet tear of the posterior leaflet were detected, and mitral valve repair was achieved without residual MR. Pathological examination of the torn chordae showed no findings of endocarditis or myxomatous degeneration. Echocardiography may play an important role for accurate and prompt diagnosis of cardiac lesions in patients with recent or a history of high-energy BCT.
Topics: Male; Humans; Middle Aged; Mitral Valve Insufficiency; Thoracic Injuries; Wounds, Nonpenetrating; Echocardiography; Mitral Valve
PubMed: 36754381
DOI: 10.2739/kurumemedj.MS681002 -
Journal of Forensic Sciences Sep 2021Blunt chest trauma (BCT) often results in blunt cardiac injuries of little clinical concern, but cases of severe heart damage with high mortality rates have also been...
Blunt chest trauma (BCT) often results in blunt cardiac injuries of little clinical concern, but cases of severe heart damage with high mortality rates have also been described. In particular, BCT should never be underestimated, especially when it is located in the anterior thoracic region. Among traffic accidents, motorcyclists are the most vulnerable and at the greatest risk. We report the case of a 14-year-old boy who experienced BCT following a motorcycle accident. He was evaluated at the hospital and was found to be in good medical condition, without bruises or rib fractures. Electrocardiography revealed a left bundle branch block. The patient was kept overnight for observation and was discharged the following morning in a good health condition. However, five days later, the patient suddenly died. Autopsy revealed a cardiac contusion associated with a full-thickness myocardial rupture and massive hemopericardium. Histologically, hemorrhagic infiltration foci, fibrin deposits, neutrophilic granulocytes, and well-defined areas of necrosis were detected in the context of recent fibrosis. Coronary thrombosis was not observed. The cause of death was identified as cardiac contusion that caused myocardial necrosis and, ultimately, cardiac rupture. Because the boy suffered a recent BCT and was assessed at the hospital, issues of medical malpractice were raised. This case demonstrates the potential lethality of blunt chest trauma in pediatric patients and demonstrates the importance of not underestimating such events, even in the absence of clinically identified chest injuries.
Topics: Accidents, Traffic; Adolescent; Bundle-Branch Block; Death, Sudden, Cardiac; Electrocardiography; Humans; Male; Motorcycles; Myocardial Contusions; Myocardium; Pericardial Effusion; Rupture
PubMed: 33960426
DOI: 10.1111/1556-4029.14741 -
Frontiers in Cardiovascular Medicine 2022A 66 years old male was admitted to our hospital after a serious car accident. The patient presented with severe shock after admission. After the examination, the...
A 66 years old male was admitted to our hospital after a serious car accident. The patient presented with severe shock after admission. After the examination, the patient was diagnosed with hemopneumothorax and myocardial contusion, accompanied by spleen rupture. After emergency surgery and a series of symptomatic treatments, the patient's condition gradually stabilized. One week later, the patient suddenly presented with severe shock. Massive hemothorax was found on the left side of the chest. Surgical exploration revealed cardiac rupture and accidental absence of congenital pericardium. According to the literature review, congenital absence of pericardium (CAP) is relatively rare. Although there are certain imaging features, the clinical diagnosis is very difficult. However, this patient did not show the characteristics in the literature and had some other atypical features. The role of CAP in the occurrence and development of the patient's heart injury and rupture is worthy of discussion. What we learned from this case is that we should look for potential risks in the telltale signs of a patient's condition.
PubMed: 36606282
DOI: 10.3389/fcvm.2022.1079670 -
International Heart Journal Jul 2018Blunt chest trauma may lead to cardiac involvement such as myocardial contusion, coronary artery dissection, cardiac rupture, or myocardial infarction. Early detection...
Blunt chest trauma may lead to cardiac involvement such as myocardial contusion, coronary artery dissection, cardiac rupture, or myocardial infarction. Early detection and treatment of complications such as these are essential. We describe a case status post collision with an iron ball and discuss how to detect myocardial infarction. We emphasize the importance of careful interview, physical examination, and electrocardiogram even in seemingly healthy patients. A severe blow, such as that described, can impair coronary artery flow and may potentially cause myocardial infarction.
Topics: Aged; Coronary Angiography; Diagnosis, Differential; Electrocardiography; Humans; Magnetic Resonance Imaging, Cine; Male; Medical History Taking; Myocardial Contusions; Myocardial Infarction; Physical Examination; Thoracic Injuries
PubMed: 29794383
DOI: 10.1536/ihj.17-345 -
Scientific Reports May 2020Bile acids (BA), with their large hydrophobic steroid nucleus and polar groups are amphipathic molecules. In bile, these exist as micelles above their critical micellar...
Bile acids (BA), with their large hydrophobic steroid nucleus and polar groups are amphipathic molecules. In bile, these exist as micelles above their critical micellar concentration (CMC). In blood at low concentrations, these exist as monomers, initiating cellular signals. This micellar to monomer transition may involve complex thermodynamic interactions between bile salts alone or with phospholipids, i.e. mixed micelles and the aqueous environment. We therefore went on to test if therapeutically relevant changes in temperature could influence micellar behavior of bile salts, and in turn whether this affected the biological responses in cells, and in vivo. Sodium taurocholate (STC) belongs to a major class of bile salts. STC has a CMC in the 5-8 mM range and its infusion into the pancreatic duct is commonly used to study pancreatitis. We thus studied micellar breakdown of STC using isothermal titration calorimetry (ITC), dynamic light scattering and cryogenic transmission electron microscopy. Under conditions relevant to the in vivo environment (pH 7.4, Na 0.15 M), ITC showed STC to have a U shaped reduction in micellar breakdown between 37 °C and 15 °C with a nadir at 25 °C approaching ≈90% inhibition. This temperature dependence paralleled pancreatic acinar injury induced by monomeric STC. Mixed micelles of STC and 1-palmitoyl, 2-oleyl phosphatidylcholine, a phospholipid present in high proportions in bile, behaved similarly, with ≈75% reduction in micellar breakdown at 25 °C compared to 37 °C. In vivo pancreatic cooling to 25 °C reduced the increase in circulating BAs after infusion of 120 mM (5%) STC into the pancreatic duct, and duct ligation. Lower BA levels were associated with improved cardiac function, reduced myocardial damage, shock, lung injury and improved survival independent of pancreatic injury. Thus micellar breakdown of bile salts is essential for their entry into the systemic circulation, and thermodynamic interference with this may reduce their systemic entry and consequent injury during cholestasis, such as from biliary pancreatitis.
Topics: Animals; Bile Acids and Salts; Cholestasis; Humans; Inflammation; Lung Injury; Male; Mice; Micelles; Myocardial Contusions; Shock; Temperature; Thermodynamics
PubMed: 32439972
DOI: 10.1038/s41598-020-65451-w -
Medical Science Monitor : International... Jul 2017BACKGROUND Pulmonary contusion (PC) is the most frequent blunt chest injury which could be used to identify patients at high-risk of clinical deterioration. We aimed to...
BACKGROUND Pulmonary contusion (PC) is the most frequent blunt chest injury which could be used to identify patients at high-risk of clinical deterioration. We aimed to investigate the clinical correlation between PC volume and outcome in patients with blunt chest trauma (BCT). MATERIAL AND METHODS BCT patients with PC were identified retrospectively from the prospectively collected trauma registry database over a 2-year period. Contusion volume was measured and expressed as percentage of total lung (CTCV) volume using three-dimensional reconstruction of thoracic CT images on admission. Data included patients' demographics, mechanism of injury (MOI) and injury severity, associated injuries, CTCV, mechanical ventilation, complications, and mortality. RESULTS A total of 226 BCT patients were identified to have PC with a mean age of 35.2 years. Motor vehicle crash (54.4%) and falls (16.4%) were the most frequent MOIs. Bilateral PC (61.5%) was more prevalent than right-sided (19.5%) and left-sided PC (19%). CTCV had a significant positive correlation with ISS; whereas, age and PaO2/FiO2 ratio showed a negative correlation (p<0.05 for all). The median CTCV was significantly higher in patients who developed in-hospital complications (p=0.02). A CTCV >20% was associated with increasedrisk of acute respiratory distress syndrome (ARDS), blood transfusion and prolonged mechanical ventilation. However, multiple linear regression analysis showed that CTCV alone was not an independent predictor of in-hospital outcomes. Presence of chest infection, CTCV, and Injury Severity Scores were predictors of ARDS. CONCLUSIONS Quantifying pulmonary contusion volume could allow identification of patients at high-risk of ARDS. CTCV has a significant correlation with injury severity in patients with BCT. Further prospective studies are needed to address the validity of CTCV in the patients care.
Topics: Adult; Contusions; Female; Humans; Lung Injury; Lung Volume Measurements; Male; Middle Aged; Myocardial Contusions; Prognosis; Respiration, Artificial; Respiratory Distress Syndrome; Retrospective Studies; Risk Factors; Thoracic Injuries; Tomography, X-Ray Computed; Trauma Severity Indices; Wounds, Nonpenetrating
PubMed: 28746303
DOI: 10.12659/msm.902197 -
Cureus May 2023Introduction Cardiac troponin (cTn) forms an essential part of the diagnostic criteria for myocardial infarction (MI). Type 1 MI is a primary coronary arterial event,...
Introduction Cardiac troponin (cTn) forms an essential part of the diagnostic criteria for myocardial infarction (MI). Type 1 MI is a primary coronary arterial event, whereas type 2 MI is due to coronary oxygen supply/demand mismatch, which is common in trauma patients. In addition, cTn may be elevated for many reasons other than MI. cTn elevations in trauma may not be specific for MI amenable to revascularization. The aim of this study is to determine which subset of trauma patients benefits from measuring cTn, and which patients with elevated cTn benefit from ischemic workup. Methods This is a retrospective cohort study. All patients on the trauma service of a level 1 trauma center with cTn elevated above the upper reference value of 0.032 ng/ml from July 2017 through December 2020 were selected. Baseline characteristics were recorded. The main outcomes were cardiology determination of the etiology of elevated cTn and patient survival. Logistic regression was used for multivariate analysis. Results One hundred forty-seven (147; 1.1%) of 13746 trauma patients had maximum cTn over the 99th percentile. Forty-one (27.5%) of the 147 had ischemic changes on electrocardiogram (ECG). Sixty-four (43.0%) had chest pain. In 81 (55.1%) cases, cTn was ordered without a clearly justified indication. One hundred thirty-seven patients (93.3%) received a cardiology consult. Two (1.5%) of 137 patients had a type 1 MI, which was diagnosed by ECG and clinical symptoms before cTn results were available. One hundred thirty-five patients were evaluated for cardiac ischemia based on elevated cTn. In 91 (66.4%) cases, the elevated cTn was attributed to a cardiac oxygen supply/demand mismatch. The etiology was cardiac contusion for 26 (19.0%), with the rest attributed to various other trauma-related causes. The cardiology consult changed management for 90 (65.7%) patients, mainly consisting of further evaluation by echocardiogram for 78 (57.0%) patients. Elevated cTn was a significant independent predictor of death with an adjusted odds ratio of 2.6 (p=0.002). Conclusion Isolated cTn values in trauma are most often due to type 2 MI resulting from trauma-related issues, such as tachycardia and anemia, which affect myocardial oxygen supply and demand. Changes in management generally consisted of further workup and interventions such as monitoring and pharmacologic treatment. Elevated cTn in this cohort never led to revascularization but was valuable to identify patients who required more intensive monitoring, longer-term follow-up, and supportive cardiac care. More selective ordering of cTn would improve specificity for patients requiring specialized cardiac care.
PubMed: 37398763
DOI: 10.7759/cureus.39711 -
Archivos Argentinos de Pediatria Apr 2023Commotio cordis or cardiac concussion is a rare and fatal mechano-electric arrhythmogenic syndrome. It is the second most common cause of sudden cardiac death in young...
Commotio cordis or cardiac concussion is a rare and fatal mechano-electric arrhythmogenic syndrome. It is the second most common cause of sudden cardiac death in young athletes. It is most commonly associated with a sports-related injury, wherein, there is a high-velocity impact between a projectile and the precordium, causing arrhythmia that leads to the immediate death of the individual without cardiac resuscitation. On autopsy, the heart is structurally normal. With increasing awareness of this condition and community training in cardiopulmonary resuscitation, survival rates have been improving. The objective of this study is to describe the case of a patient who arrived at our hospital with commotio cordis and his course, emphasizing the importance of prevention and training of the population in cardiopulmonary resuscitation techniques and the use of the automated external defibrillator for the survival of patients suffering from commotio cordis.
Topics: Humans; Child; Commotio Cordis; Death, Sudden, Cardiac; Cardiopulmonary Resuscitation; Athletic Injuries; Autopsy; Wounds, Nonpenetrating
PubMed: 36315904
DOI: 10.5546/aap.2022-02593.eng -
Oman Medical Journal May 2021We present a case that was initially diagnosed as non-ST segment elevation myocardial infarction following a blunt chest trauma from left lateral contusion. Coronary...
We present a case that was initially diagnosed as non-ST segment elevation myocardial infarction following a blunt chest trauma from left lateral contusion. Coronary angiography and later cardiac computed tomography were performed that showed narrowing and dissection of the distal circumflex and first obtuse marginal branch artery, which was treated medically without any coronary intervention.
PubMed: 34239715
DOI: 10.5001/omj.2021.30 -
Bulletin of Emergency and Trauma Jul 2021Blunt chest trauma is a rare cause of acute coronary syndrome and can be masked by other injuries in polytrauma patients. It can have devastating consequences due to...
Blunt chest trauma is a rare cause of acute coronary syndrome and can be masked by other injuries in polytrauma patients. It can have devastating consequences due to damage to the myocardial tissue if left un-recognized. Myocardial injury can result in life-threatening arrhythmias and complications such as systolic and diastolic dysfunction. This can significantly affect patients' quality of life. A 34-year-old man involved in a paragliding incident in Kazakhstan. His equipment failed at 30 meters height and result him to be propelled at high velocity to the ground. He sustained multiple injuries including spinal fractures, lung contusions and a mediastinal haematoma. He was transported to a local hospital and noted to have ST segment elevation on his admission electrocardiogram (ECG). He underwent an angiogram that showed sub-occlusion of his left anterior descending (LAD) artery. This resulted in a time-critical Percutaneous Coronary Intervention (PCI). He was stabilized and repatriated to the UK to manage of remaining injuries.
PubMed: 34307706
DOI: 10.30476/BEAT.2021.87689.1192