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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 -
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 -
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 -
Canadian Respiratory Journal 2020Prognostic determinants in thoracic trauma are of major public health interest. We intended to describe patterns of thoracic trauma, demographic factors, clinical...
Prognostic determinants in thoracic trauma are of major public health interest. We intended to describe patterns of thoracic trauma, demographic factors, clinical course, and predictors of outcome in selected tertiary care hospitals in Sri Lanka. A multicentre prospective cohort study was conducted in five leading teaching hospitals from June to September 2017. Patients with thoracic trauma were followed up during the hospital stay. A logistic regression analysis was conducted using in-hospital morbidity as the dichotomous outcome variable. One hundred seventy-one patients were included in the study yielding 1450 (median = 8.5) person-days of observation. Of them, 71.9% ( = 123) were males. The mean age was 45.8 ± 17.9 years. Majority (39.2%, = 67) were recruited from the National Hospital of Sri Lanka. Automobile accidents were the commonest (62.6%, = 107), followed by falls (26.9%, = 46), assaults (8.8%, = 15), and animal attacks (1.8%, = 3). The ratio of blunt to penetrating trauma was 5.6 : 1. Injury patterns were rib fractures (80.7%, = 138), haemothorax (44.4%, = 76), pneumothorax (44.4%, = 76), lung contusion (22.8%, = 39), flail segment (15.8%, = 27), tracheobronchial trauma (7.0%, = 12), diaphragmatic injury (2.3%, = 4), vascular injury (2.3%, = 4), cardiac contusions (1.1%, = 2), and oesophageal injury (0.6%, = 1). Ninety nine (57.9%) had extrathoracic injuries. Majority (63.2%, = 108) underwent operative management including intercostal tube insertion (60.8%, = 104), wound exploration (6.4%, = 11), thoracotomy (4.1%, = 7), rib reconstruction (4.1%, = 7), and video-assisted thoracoscopic surgery (2.9%, = 5). Pneumonia (10.5%, = 8), bronchopleural fistulae (2.3%, = 4), tracheaoesophageal fistulae (1.8%, = 3), empyema (1.2%, = 2), and myocardial infarction (1.2%, = 2) were the commonest postoperative complications. The mean hospital stay was 15.6 ± 18.0 days. The in-hospital mortality was 11 (6.4%). The binary logistic regression analysis with five predictors (age, gender, mechanism of injury (automobile/fall/assault), type of trauma (blunt/penetrating), and the presence of extrathoracic injuries) was statistically significant to predict in-hospital morbidity ( (6, = 168) = 13.1; =0.041), explaining between 7.5% (Cox and Snell ) and 14.5% (Nagelkerke ) of variance. The automobile accidents (OR: 2.3, 95% CI = 0.2-26.2) and being males (OR: 2.3, 95% CI = 0.6-9.0) were the strongest predictors of morbidity.
Topics: Cohort Studies; Female; Hospital Mortality; Humans; Length of Stay; Male; Middle Aged; Postoperative Complications; Prospective Studies; Sri Lanka; Surgical Procedures, Operative; Tertiary Care Centers; Thoracic Injuries; Trauma Severity Indices; Wounds, Nonpenetrating; Wounds, Penetrating
PubMed: 32655722
DOI: 10.1155/2020/1219439 -
Heart (British Cardiac Society) Jul 2020We assessed the diagnostic and prognostic implications of early cardiac magnetic resonance (CMR), CMR-based deformation imaging and conventional risk factors in patients... (Observational Study)
Observational Study
OBJECTIVE
We assessed the diagnostic and prognostic implications of early cardiac magnetic resonance (CMR), CMR-based deformation imaging and conventional risk factors in patients with troponin-positive acute chest pain and non-obstructed coronary arteries.
METHODS
In total, 255 patients presenting between 2009 and 2019 with troponin-positive acute chest pain and non-obstructed coronary arteries who underwent CMR in ≤7 days were followed for a clinical endpoint of all-cause mortality. Cine movies, T2-weighted and late gadolinium-enhanced images were evaluated to establish a diagnosis of the underlying heart disease. Further CMR analysis, including left ventricular strain, was carried out.
RESULTS
CMR (performed at a mean of 2.7 days) provided the diagnosis in 86% of patients (54% myocarditis, 22% myocardial infarction (MI) and 10% Takotsubo syndrome and myocardial contusion (n=1)). The 4-year mortality for a diagnosis of MI, myocarditis, Takotsubo and normal CMR patients was 10.2%, 1.6%, 27.3% and 0%, respectively. We found a strong association between CMR diagnosis and mortality (log-rank: 24, p<0.0001). Takotsubo and MI as the diagnosis, age, hypertension, diabetes, female sex, ejection fraction, stroke volume index and most of the investigated strain parameters were univariate predictors of mortality; however, in the multivariate analysis, only hypertension and circumferential mechanical dispersion measured by strain analysis were independent predictors of mortality.
CONCLUSIONS
CMR performed in the early phase establishes the proper diagnosis in patients with troponin-positive acute chest pain and non-obstructed coronary arteries and provides additional prognostic factors. This may indicate that CMR could play an additional role in risk stratification in this patient population.
Topics: Adult; Aged; Angina Pectoris; Biomarkers; Coronary Artery Disease; Databases, Factual; Diagnosis, Differential; Female; Humans; Longitudinal Studies; Magnetic Resonance Imaging, Cine; Male; Middle Aged; Myocardial Contusions; Myocardial Infarction; Myocarditis; Predictive Value of Tests; Prognosis; Retrospective Studies; Risk Assessment; Risk Factors; Takotsubo Cardiomyopathy; Time Factors; Troponin; Young Adult
PubMed: 32447308
DOI: 10.1136/heartjnl-2019-316295 -
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 -
European Journal of Trauma and... Aug 2021Myocardial contusion can be a life-threatening condition in patients who sustained blunt thoracic trauma. The diagnostic approach remains a subject of debate. The aim of... (Meta-Analysis)
Meta-Analysis
PURPOSE
Myocardial contusion can be a life-threatening condition in patients who sustained blunt thoracic trauma. The diagnostic approach remains a subject of debate. The aim of this study was to determine the sensitivity and specificity of echocardiography, electrocardiography, troponins T and I (TnT and TnI), and creatine kinase muscle/brain (CK-MB) for identifying patients with a myocardial contusion following blunt thoracic trauma.
METHODS
Sensitivity and specificity were first determined in a 10-year retrospective cohort study and second by a systematic literature review with meta-analysis.
RESULTS
Of the 117 patients in the retrospective study, 44 (38%) were considered positive for myocardial contusion. Chest X-ray, chest CT scan, electrocardiograph, and echocardiography had poor sensitivity (< 15%) but good specificity (≥ 90%). Sensitivity to cardiac biomarkers measured at presentation ranged from 59% for TnT to 77% for hs-TnT, specificity ranged from 63% for CK-MB to 100% for TnT. The systematic literature review yielded 28 studies, with 14.5% out of 7242 patients reported as positive for myocardial contusion. The pooled sensitivity of electrocardiography, troponin I, and CK-MB was between 62 and 71%, versus only 45% for echocardiography and 38% for troponin T. The pooled specificity ranged from 63% for CK-MB to 85% for troponin T and 88% for echocardiography.
CONCLUSION
The best diagnostic approach for myocardial contusion is a combination of electrocardiography and measurement of cardiac biomarkers. If abnormalities are found, telemonitoring is necessary for the early detection of life-threatening arrhythmias. Chest X-ray and CT scan may show other thoracic injuries but provide no information on myocardial contusion.
Topics: Biomarkers; Electrocardiography; Humans; Myocardial Contusions; Retrospective Studies; Sensitivity and Specificity; Thoracic Injuries; Troponin T
PubMed: 31982920
DOI: 10.1007/s00068-020-01305-4 -
Heart Rhythm Apr 2020
Topics: Commotio Cordis; Death, Sudden, Cardiac; History, 19th Century; Humans; Italy; Thoracic Injuries
PubMed: 31981737
DOI: 10.1016/j.hrthm.2020.01.020 -
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 -
Anesthesiology and Pain Medicine Apr 2019Myocardial dysfunction is frequently described as an underlying cause of mortality in traumatic brain injury (TBI) known as brain-cardiac link. However the impact on...
BACKGROUND
Myocardial dysfunction is frequently described as an underlying cause of mortality in traumatic brain injury (TBI) known as brain-cardiac link. However the impact on prognosis of a disease remains uncertain.
OBJECTIVES
The current study aimed at investigating the correlation between TBI and cardiac troponin I (cTnI) rise and in-hospital mortality rate among patients with TBI.
METHODS
In the current prospective study TBI patients with abbreviated injury scale score (AIS) > 3 and Glasgow coma scale (GCS) score ≤ 8 with cTnI measurement within the first 24 hours of admission were evaluated. Chi-square, Kruskal-Wallis, Mann-Whitney U and Logistic Regression tests were used for data analysis.
RESULTS
A total of 166 eligible patients were studied .The mean age of the cases was 37.64 ± 17.21 years, largely under 65 (93.4%) and male (86.7%).The most common injuries were cerebral contusion (35.1%), while motor vehicle crash (MVC) was the most common cause of injuries (83.73%); 59 % of the patients showed detectable cTnI concentrations within 24 hours of admission; 65.7% of the patients expired; they showed higher levels of cTnI compared to survivors that showed lower levels, 0.148 ± 0.074 vs 0.057 ± 0.055, respectively (P < 0.001). Moreover, a significant association was observed between mortality rate and lower admission GCS 3.49 ± 1.08 vs 6.79 ± 1.66, respectively (P < 0.001).
CONCLUSIONS
Increased cTnI levels could be a predictor of mortality among patients with TBI. Its measurement and investigation for therapeutic strategies could lead to better management of these cases.
PubMed: 31341829
DOI: 10.5812/aapm.90858