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BMJ Case Reports Apr 2021A 47-year-old man sustained multisystem injuries after being struck by a vehicle travelling at high speeds. Shortly after admission to the emergency department he...
A 47-year-old man sustained multisystem injuries after being struck by a vehicle travelling at high speeds. Shortly after admission to the emergency department he suffered a ventricular tachycardia/ventricular fibrillation cardiac arrest lasting 30 min. Investigations following return of spontaneous circulation raised suspicion for an anterolateral ST-elevation myocardial infarction. Despite his major traumatic injuries the patient was transferred for percutaneous coronary intervention uncovering a complete thrombosis of the ostium of the left anterior descending artery. Immediately following coronary revascularisation, the patient developed cardiogenic shock resulting in a multidisciplinary decision to place the patient on veno-arterial extracorporeal membrane oxygenation (VA-ECMO). The management of cardiogenic shock due to acute myocardial infarction with VA-ECMO and multiple traumatic injuries were often at odds with each other, resulting in a series of challenging decisions on timing of surgery and anticoagulation. The patient was liberated from VA-ECMO after 72 hours and continues rehabilitation in hospital.
Topics: Extracorporeal Membrane Oxygenation; Heart Arrest; Humans; Male; Middle Aged; Myocardial Contusions; Myocardial Infarction; Shock, Cardiogenic
PubMed: 33832936
DOI: 10.1136/bcr-2020-241034 -
Cureus Nov 2022Despite the reserve for recovery in pediatric trauma, blunt force chest trauma can cause insidious injuries that are easy to miss. Coronary artery dissection is a rare...
Despite the reserve for recovery in pediatric trauma, blunt force chest trauma can cause insidious injuries that are easy to miss. Coronary artery dissection is a rare injury associated with blunt force chest trauma in the pediatric population and can present with vague or atypical symptoms. Pediatric patients can be unreliable in reporting symptoms, and providers can mistake coronary artery injuries for myocardial contusion, especially with improving laboratory tests and equivocal imaging. We report a case showing the importance of a high index of suspicion when presented with this trauma pattern in a pediatric patient.
PubMed: 36532932
DOI: 10.7759/cureus.31477 -
Circulation. Arrhythmia and... Apr 2024Commotio cordis, sudden cardiac death (SCD) caused by relatively innocent impact to the chest, is one of the leading causes of SCD in sports. Commercial chest protectors...
BACKGROUND
Commotio cordis, sudden cardiac death (SCD) caused by relatively innocent impact to the chest, is one of the leading causes of SCD in sports. Commercial chest protectors have not been demonstrated to mitigate the risk of these SCDs.
METHODS
To develop a standard to assess chest protectors, 4 phases occurred. A physiological commotio cordis model was utilized to assess variables that predicted for SCD. Next, a surrogate model was developed based on data from the physiological model, and the attenuation in risk was assessed. In the third phase, this model was calibrated and validated. Finally, National Operating Committee on Standards for Athletic Equipment adopted the standard and had an open review process with revision of the standard over 3 years.
RESULTS
Of all variables, impact force was the most robust at predicting SCD. Chest wall protectors which could reduce the force of impact to under thresholds were predicted to reduce the risk of SCD. The correlation between the experimental model and the mechanical surrogate ranged from 0.783 with a lacrosse ball at 30 mph to 0.898 with a baseball at 50 mph. The standard was licensed to National Operating Committee on Standards for Athletic Equipment which initially adopted the standard in January 2018, and finalized in July 2021.
CONCLUSIONS
An effective mechanical surrogate based on physiological data from a well-established model of commotio cordis predicts the reduction in SCD with chest protectors. A greater reduction in force provides a great degree of protection from commotio cordis. This new National Operating Committee on Standards for Athletic Equipment standard for chest protectors should result in a significant reduction in the risk of commotio cordis on the playing field.
Topics: Humans; Commotio Cordis; Ventricular Fibrillation; Death, Sudden, Cardiac; Sports Equipment; Thorax; Wounds, Nonpenetrating
PubMed: 38390710
DOI: 10.1161/CIRCEP.123.011966 -
Commotio Cordis Returns…When We Least Expected It: Cardiac Arrest in A Professional Football Player.The American Journal of Cardiology Sep 2023For the first time in 52 years, an American professional football player (Damar Hamlin) collapsed in cardiac arrest during a game, viewed in real-time on national...
For the first time in 52 years, an American professional football player (Damar Hamlin) collapsed in cardiac arrest during a game, viewed in real-time on national television. The cause of this profound event was commotio cordis, that is, blunt non-penetrating chest blow-initiated ventricular fibrillation triggered by physical contact not considered unusual for football. The athlete survived because of timely cardiopulmonary resuscitation and defibrillation provided by first responders organized by the National Football League. Commotio cordis, albeit rare, was most prominently identified initially in competitive and also recreational sports participants. More recently it became apparent that similar events could occur in almost any circumstance involving a chest blow, such as during everyday activities around the home and with innocent play. The determinant of a commotio cordis event is a blow over the heart in a narrow vulnerable electrical window during dispersion of repolarization. Survival from these events has increased substantially to >60% due to enhanced recognition and prompt resuscitation/defibrillation. In conclusion, in this commentary, we take a timely opportunity to describe in detail the relevant demographics, mechanism/pathophysiology, and clinical course of commotio cordis.
Topics: Humans; Commotio Cordis; Football; Cardiopulmonary Resuscitation; Arrhythmias, Cardiac; Death, Sudden, Cardiac; Ventricular Fibrillation; Heart Arrest; Wounds, Nonpenetrating
PubMed: 37495440
DOI: 10.1016/j.amjcard.2023.06.027 -
Veterinaria Italiana Sep 2019An adult male Eurasian otter, found dead on the roadside, was submitted for post-mortem examination in April 2014 at the Veterinary Pathology Unit of the Faculty of...
An adult male Eurasian otter, found dead on the roadside, was submitted for post-mortem examination in April 2014 at the Veterinary Pathology Unit of the Faculty of Veterinary Medicine of Teramo, as part of the RECAL [RECovery and post mortem Analysis of Eurasian otters (Lutra lutra) in the National Park of Cilento, Vallo di Diano and Alburni (Salerno, Italy), and surrounding areas] project. Necropsy revealed an abundant hemothorax associated with multifocal, bilateral pulmonary contusions and lacerations, and a severe hemopericardium characterised by the presence of a wide blood clot in the intact pericardial sac. Two small laceration wounds of the left auricle were found at the base, along the atrioventricular groove, and on the outer free wall. Since myocardial and endocardial tissues showed no other gross and histopathological abnormalities, a left atrial appendage rupture resulting from a blunt chest trauma was diagnosed. Blunt traumatic cardiac rupture is a rarely reported, life-threatening condition in humans. To the best of our knowledge, this is the first report on a left atrial appendage rupture due to blunt chest trauma in veterinary literature. The possible occurrence of a cardiac rupture following a blunt thoracic injury should be taken into consideration in veterinary emergency care.
Topics: Animals; Atrial Appendage; Fatal Outcome; Heart Injuries; Italy; Male; Otters; Thoracic Injuries; Wounds, Nonpenetrating
PubMed: 31599553
DOI: 10.12834/VetIt.872.4309.2 -
Journal of Investigative Medicine High... 2020Penetrative cardiac injury can often result in life-threatening sequelae such as myocardial contusion or rupture, coronary vessel and valvular damage, pericardial...
Penetrative cardiac injury can often result in life-threatening sequelae such as myocardial contusion or rupture, coronary vessel and valvular damage, pericardial effusion with tamponade, and arrhythmias of which gunshot injury is a chief culprit. We report a case of a suspected acute coronary syndrome after a cardiac gunshot injury that was conservatively managed.
Topics: Acute Coronary Syndrome; Cardiac Tamponade; Foreign Bodies; Humans; Male; Middle Aged; Pericardial Effusion; Radiography, Thoracic; Tomography, X-Ray Computed; Wounds, Gunshot
PubMed: 32815420
DOI: 10.1177/2324709620951652 -
The Journal of Tehran Heart Center Apr 2022Injuries to the heart and great vessels should always be considered after blunt chest trauma. Valvular damage rarely occurs after blunt trauma, but symptoms may be...
Injuries to the heart and great vessels should always be considered after blunt chest trauma. Valvular damage rarely occurs after blunt trauma, but symptoms may be delayed. A 58-year-old woman was referred to our hospital with exertional dyspnea (functional class III) and palpitations for elective transesophageal echocardiography. Her symptoms had exacerbated in the preceding 2 or 3 months. Physical examination showed holosystolic murmurs (IV/VI) at the lower sternal border with extension to the apex. Transesophageal echocardiography revealed avulsion of the base of the posterior mitral valve leaflet (P3) from the annulus. In the past medical history, there was a history of a motor vehicle accident 9 months earlier. The patient was recommended for mitral valve surgery. Mitral valve replacement was performed, and the diagnosis was confirmed by surgery. The patient was discharged without any complications.
PubMed: 36567937
DOI: 10.18502/jthc.v17i2.9845 -
Cureus Sep 2020Blunt chest trauma (BCT) has become increasingly more prevalent in recent years. As a result, the incidence of blunt cardiac injury (BCI), or cardiac or myocardial...
Blunt chest trauma (BCT) has become increasingly more prevalent in recent years. As a result, the incidence of blunt cardiac injury (BCI), or cardiac or myocardial contusion, has also increased. The sequelae of BCI often are undiagnosed due to variability in the clinical presentation. This case highlights a transient right bundle branch block (RBBB) following a motor vehicle accident (MVA), resulting in BCI. Right-sided cardiac injuries predominate BCI owing to the anterior location of the right ventricle within the thoracic cage; however, the pathophysiologic mechanisms underlying the electrocardiographic manifestations are vaguely understood. In this case, a 66-year-old female sustained a BCI resulting in a transient RBBB. The patient fully recovered following a three-day hospitalization with complete recovery of normal cardiac conduction.
PubMed: 33094074
DOI: 10.7759/cureus.10534 -
BMJ Case Reports Apr 2024A man in his 20s with no medical illness sustained a blunt chest injury with pneumothorax and lung contusion after involving in a motorbike accident. Five days...
A man in his 20s with no medical illness sustained a blunt chest injury with pneumothorax and lung contusion after involving in a motorbike accident. Five days postadmission, he subsequently had myocardial infarction with cardiac arrest, in which coronary angiogram and intravascular ultrasound showed diffused multivessel coronary artery dissection.
Topics: Humans; Male; Wounds, Nonpenetrating; Thoracic Injuries; Myocardial Infarction; Coronary Angiography; Coronary Vessels; Accidents, Traffic; Adult; Aortic Dissection; Ultrasonography, Interventional
PubMed: 38684352
DOI: 10.1136/bcr-2024-260649