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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 -
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 -
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 -
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 -
BMC Cardiovascular Disorders Jun 2022Commotio cordis is an event in which a blunt, non-penetrating blow to the chest occurs, triggering a life-threatening arrhythmia and often sudden death. This phenomenon...
BACKGROUND
Commotio cordis is an event in which a blunt, non-penetrating blow to the chest occurs, triggering a life-threatening arrhythmia and often sudden death. This phenomenon is often seen in young, male athletes and has become increasingly well-known over the past few decades. We present a unique case in which ventricular fibrillation occurs in an older male athlete after blunt trauma.
CASE PRESENTATION
Patient with no known medical history was brought to the ER after being found unconscious after a soccer ball kick to the chest. He was found to be in ventricular fibrillation and successfully resuscitated on the soccer field. Patient was admitted to the hospital and lab workup and initial imaging were unremarkable, except elevated troponin and lactate, which returned to normal levels. An echocardiogram showed global left ventricular systolic dysfunction with a visually estimated ejection fraction of 45-50%. Coronary showed angiographically nonobstructive coronary arteries. The patient was diagnosed with commotio cordis and discharged from the hospital in stable condition. Follow-up echocardiogram continued to show low ejection fraction and event monitor demonstrated frequent polymorphic ventricular tachycardia with periods of asystole.
CONCLUSION
This case is unique in that blunt trauma to the chest from a soccer ball immediately triggered ventricular fibrillation in a patient with a possible cardiomyopathy. It is possible that the blunt trauma caused primary commotio cordis that led to cardiomyopathy in a previous healthy man, or that an underlying cardiomyopathy made it more likely for this to occur. Overall, increased awareness and prevention efforts of blunt chest trauma are required to reduce the high mortality associated life-threatening arrhythmias. There is limited data regarding the interplay between these two entities.
Topics: Adult; Arrhythmias, Cardiac; Commotio Cordis; Death, Sudden, Cardiac; Humans; Male; Thoracic Injuries; Ventricular Fibrillation; Wounds, Nonpenetrating
PubMed: 35658897
DOI: 10.1186/s12872-022-02689-4 -
Computational and Mathematical Methods... 2020As many as 80% of patients with TAR die on the spot while out of those reaching a hospital, 30% would die within 24 hours. Thus, it is essential to better understand and...
As many as 80% of patients with TAR die on the spot while out of those reaching a hospital, 30% would die within 24 hours. Thus, it is essential to better understand and prevent this injury. The exact mechanics of TAR are unknown. Although most researchers approve it as a common-sense deceleration injury, the exact detailed mechanism of TRA still remains unidentified. In this work, a deceleration mechanism of TAR was carried out using finite element analysis (FEA). The FE analysis aimed to predict internal kinematics of the aorta and assist to comprehend the mechanism of aorta injury. The model contains the heart, lungs, thoracic aorta vessel, and rib cage. High-resolution computerized tomography (HR CT scan) was used to provide pictures that were reconstructed by MIMICS software. ANSYS FE simulation was carried out to investigate the behavior of the aorta in the thoracic interior after deceleration occurred during a car crash. The finite element analysis indicated that maximum stress and strain applied to the aorta were from 5.4819e5 to 2.614e6 Pa and 0.21048 to 0.62676, respectively, in the -direction when the initial velocity increased from 10 to 25 m/s. Furthermore, in the -direction when the velocity changed from 15 to 25 m/s, the stress and strain values increased from 5.17771e5 to 2.3128e6 and from 0.22445 to 0.618, respectively.
Topics: Acceleration; Accidents, Traffic; Aorta; Aortic Rupture; Biomechanical Phenomena; Computational Biology; Computer Simulation; Finite Element Analysis; Humans; Imaging, Three-Dimensional; Mathematical Concepts; Models, Cardiovascular; Myocardial Contusions; Stress, Mechanical; Tomography, X-Ray Computed
PubMed: 32724330
DOI: 10.1155/2020/6718495 -
Emergent surgery for cardiac herniation coexisting with complex blunt cardiac injury: A case report.Trauma Case Reports Apr 2021A 38-year-old man was pressed on his trunk by a heavy object weighing about 100 kg. The patient was in shock status on arrival to the hospital. Circular collapse...
A 38-year-old man was pressed on his trunk by a heavy object weighing about 100 kg. The patient was in shock status on arrival to the hospital. Circular collapse progressed rapidly during contrast computed tomography (CT) scanning. CT images revealed exacerbation of the right lateral deviation of the heart that was earlier seen on X-ray imaging. Considering cardiac herniation based on CT findings, we immediately performed resuscitative thoracotomy and clamshell thoracotomy at the emergency department. Intraoperative findings showed a pericardial defect, and the heart had deviated to the right thoracic cavity. Immediate repositioning revealed a marked improvement in circulation. Full-thickness cardiac injury was observed in the anterior wall of the left ventricle; no active bleeding was observed. We performed temporary thoracic wall closure after cardiorraphy for damage control. After admission to the intensive care unit, he presented with respiratory failure associated with pulmonary contusion. Therefore, veno-venous extracorporeal membrane oxygenation (V-V ECMO) was used from the 2nd to the 5th hospital day. After confirming no intra-thoracic events on the 6th hospital day, chest wall closure was performed. The patient subsequently developed heart failure and mitral regurgitation associated with papillary muscle rupture. On the 62nd hospital day, he underwent mitral annuloplasty at the cardiovascular surgery division; After rehabilitation till 152nd hospital day, he was discharged without any neurological abnormality. This was an extremely rare case with concomitant full-thickness myocardial injury, intracardiac injury, and cardiac herniation. Rapid resuscitative thoracotomy and damage control including V-V ECMO yielded good results. Retrospectively, cardiac herniation should have been suspected earlier basis this observation. Our report highlights that cardiac herniation should be considered in case of cardiac shadow aberrations in cases of blunt chest trauma, familiarity with condition and its characteristic imaging findings are critical for the doctor overseeing initial trauma treatment.
PubMed: 33816745
DOI: 10.1016/j.tcr.2021.100464