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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 -
The American Surgeon Apr 2024Traumatic coronary artery occlusion and dissection is an exceedingly rare complication of blunt cardiac injury (BCI), though it has been previously noted in a number of...
Traumatic coronary artery occlusion and dissection is an exceedingly rare complication of blunt cardiac injury (BCI), though it has been previously noted in a number of case reports. However, it can also lead to heart transplant, which to our knowledge has not been previously described in the literature. We present a case of a healthy 24-year-old man without significant past medical history who was in a motorcycle accident, resulting in sternal fracture and BCI. He was ultimately found to have thrombotic occlusion and dissection of his left anterior descending artery (LAD), requiring mechanical thrombectomy and drug-eluting stent, as well as subsequent hospitalizations and operations due to various complications. It was suspected that he went into ventricular fibrillation and had a second motorcycle collision, resulting in cardiogenic shock. Ultimately, his progression of ischemic cardiomyopathy and mitral regurgitation led to the need for heart transplant. Blunt cardiac injury with myocardial contusion has such a broad range of pathologies. It is essential that patients with these injury patterns raise a high level of suspicion for BCI and are followed closely with appropriate diagnostic testing and rapid intervention for best possible outcomes.
PubMed: 38557253
DOI: 10.1177/00031348241241699 -
Circulation. Arrhythmia and... Apr 2024
Topics: Humans; Commotio Cordis; Death, Sudden, Cardiac; Ventricular Fibrillation; Marketing; Reference Standards
PubMed: 38497218
DOI: 10.1161/CIRCEP.124.012844 -
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 -
Annals of Medicine Dec 2024To determine the incidence rates (IRs) of catastrophic injuries and exertional medical events in lacrosse athletes.
OBJECTIVE
To determine the incidence rates (IRs) of catastrophic injuries and exertional medical events in lacrosse athletes.
METHODS
Catastrophic injuries and exertional medical events in lacrosse in the US among youth or amateur, high school and college athletes were analysed from the National Center for Catastrophic Sport Injury Research (NCCSIR) database from 1982/83 to 2019/20. Frequencies, IRs per 100,000 athlete-seasons (AS) with 95% confidence intervals (CIs), and incidence rate ratios (IRRs) with 95% CIs were calculated. Participation data were gathered from the National Federation of State High School Associations (NFHS), National Collegiate Athletic Association (NCAA) and USA Lacrosse.
RESULTS
Sixty-nine catastrophic events (16 youth or amateur, 36 high school and 17 college; 84% male) occurred in US lacrosse from 7/1/1982 to 6/30/2020. Thirty-six percent of all incidents were fatal. The overall IR was 0.5 per 100,000 AS (95% CI: 0.4-0.7). There were 15 cases of non-traumatic sudden cardiac arrests (SCAs) and 15 incidents of commotio cordis. Fatality rates from SCA and commotio cordis decreased 95% (IRR = 0.05; 95% CI: 0, 0.2) from 1982/83-2006/07 to 2007/08-2019/20. Incidence rates were higher for collegiate versus high school 1982/83-2019/20 (IRR = 3.2; 95% CI: 1.8, 5.7) and collegiate versus youth 2005/06-2019/20 (IRR = 8.0; 95% CI: 3.0, 21.4) level. Contact with a stick or ball (41%) and contact with another player (20%) were the primary mechanisms of injury.
CONCLUSIONS
The incidence of catastrophic events during lacrosse was higher among collegiate than high school or youth athletes. SCA from an underlying cardiac condition or from commotio cordis was the most common catastrophic event. Fatality rates from catastrophic injuries have declined significantly over the study period, perhaps driven by protective measures adopted by lacrosse governing bodies.
Topics: Humans; Male; Adolescent; United States; Female; Athletic Injuries; Commotio Cordis; Schools; Racquet Sports; Athletes; Incidence
PubMed: 38335556
DOI: 10.1080/07853890.2024.2311223 -
BMJ Case Reports Jan 2024Myocardial contusion should be suspected in a selected patient group with blunt thoracic trauma, who have elevated troponin, ECG changes and/or haemodynamical...
Myocardial contusion should be suspected in a selected patient group with blunt thoracic trauma, who have elevated troponin, ECG changes and/or haemodynamical instability. Echocardiography is useful for direct visualisation of possible complications. In stable conditions, MRI allows for good visualisation of the heart and can confirm a suspected myocardial contusion as well as demonstrate the extent of myocardial damage. Based on the present literature, the authors developed a diagram for the diagnostic approach of a patient with suspected myocardial contusion.
Topics: Humans; Heart Injuries; Myocardial Contusions; Troponin; Echocardiography; Wounds, Nonpenetrating; Thoracic Injuries; Contusions; Electrocardiography
PubMed: 38272515
DOI: 10.1136/bcr-2023-257082 -
JAAPA : Official Journal of the... Feb 2024Blunt cardiac injury (BCI) describes a spectrum of problems including severe, potentially life-threatening injuries from trauma. Pericardial effusion is an example of a...
Blunt cardiac injury (BCI) describes a spectrum of problems including severe, potentially life-threatening injuries from trauma. Pericardial effusion is an example of a BCI that has generally been assumed to imply serious underlying injury to the heart and should be considered hemopericardium until proven otherwise. A standard of care has been established to screen for BCI and treat hemodynamically unstable patients with an acute pericardial effusion presumably related to BCI. Less agreement exists on definitive treatment for hemodynamically stable patients with pericardial effusion after blunt cardiac trauma. This case study explores a new treatment for small to moderate hemopericardium in a stable patient after BCI.
Topics: Humans; Pericardial Effusion; Patients; Wounds, Nonpenetrating; Myocardial Contusions
PubMed: 38270655
DOI: 10.1097/01.JAA.0000997692.54661.95 -
Cardiovascular Pathology : the Official... 2024Sudden death by commotio cordis is rare. It is the consequence of a blunt trauma of the chest overlying the heart. The mechanism is a cardiac arrest by ventricular...
Sudden death by commotio cordis is rare. It is the consequence of a blunt trauma of the chest overlying the heart. The mechanism is a cardiac arrest by ventricular fibrillation in the absence of grossly or microscopically apparent myocardial injury. It has been reproduced in animals. The first historical case was reported by Giovanni Maria Lancisi in his book "De Subitaneis Mortibus'' published in 1707. Sudden death occurred in a man receiving a powerful blow under the xiphoid cartilage. Lancisi advanced the hypothesis of acute heart failure by a diastolic stand still ("death in diastole'').
Topics: Humans; Commotio Cordis; History, 18th Century; Death, Sudden, Cardiac; Male; Heart Arrest; Wounds, Nonpenetrating; Ventricular Fibrillation
PubMed: 38262503
DOI: 10.1016/j.carpath.2024.107606 -
BMJ Case Reports Jan 2024Blunt cardiac injury, including a rupture of the atria or ventricle, is most commonly caused by motor vehicle collisions and falls from great heights. A rupture of a...
Blunt cardiac injury, including a rupture of the atria or ventricle, is most commonly caused by motor vehicle collisions and falls from great heights. A rupture of a cardiac chamber is an extremely rare diagnosis with a high mortality rate. The best chance at survival can only be accomplished with timely intervention.To raise awareness of this potentially life-threatening injury, we describe the case of a male adolescent with cardiac rupture after blunt thoracic trauma. While the focused assessment with sonography in trauma (FAST) examination was negative, an additional CT showed pericardial effusion. During the operation a rupture of the right ventricle was observed.Even though the physical recovery of our patient is remarkable, the traumatic event still affects his mental well-being and activities in daily life. This case emphasises the need of a multidisciplinary approach to achieve the best possible physical and psychological recovery in multitrauma patients.
Topics: Humans; Male; Adolescent; Thoracic Injuries; Heart Rupture; Rupture; Heart Atria; Myocardial Contusions; Wounds, Nonpenetrating; Heart Injuries
PubMed: 38216168
DOI: 10.1136/bcr-2023-256042 -
The Journal of Trauma and Acute Care... May 2024Blunt cardiac injury (BCI) encompasses a wide spectrum, from occult and inconsequential contusion to rapidly fatal cardiac rupture. A small percentage of patients... (Review)
Review
Blunt cardiac injury (BCI) encompasses a wide spectrum, from occult and inconsequential contusion to rapidly fatal cardiac rupture. A small percentage of patients present with abnormal electrocardiogram or shock, but most are initially asymptomatic. The potential for sudden dysrhythmia or cardiac pump failure mandates consideration of the presence of BCI, including appropriate monitoring and management. In this review, we will present what you need to know to diagnose and manage BCI.
Topics: Humans; Wounds, Nonpenetrating; Heart Injuries; Myocardial Contusions; Electrocardiography
PubMed: 37968802
DOI: 10.1097/TA.0000000000004216