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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 -
BMJ Case Reports Jul 2017This report describes a paediatric patient presenting with haemodynamically stable non-sustained ventricular tachycardia 1 day after minor blunt chest trauma. Initial...
This report describes a paediatric patient presenting with haemodynamically stable non-sustained ventricular tachycardia 1 day after minor blunt chest trauma. Initial laboratory studies, chest X-ray and echocardiography were normal; however, cardiac MRI revealed precordial haematoma, myocardial contusion and small pericardial effusion. Throughout her hospital course, she remained asymptomatic aside from frequent couplets and triplets of premature ventricular contractions. Ectopy was controlled with oral verapamil. This case highlights how significant cardiac injury may be missed with standard diagnostic algorithms.
Topics: Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Child; Contusions; Delayed Diagnosis; Echocardiography; Female; Heart Injuries; Heart Ventricles; Hematoma; Humans; Magnetic Resonance Imaging; Myocardial Contusions; Myocardium; Pericardial Effusion; Thoracic Injuries; Thoracic Wall; Verapamil; Wounds, Nonpenetrating
PubMed: 28739617
DOI: 10.1136/bcr-2017-220498 -
American Journal of Physiology. Heart... Nov 2017Active upper-limb and passive lower-limb exercise are two interventions used in the spinal cord injury (SCI) population. Although the global cardiac responses have been... (Comparative Study)
Comparative Study
Active upper-limb and passive lower-limb exercise are two interventions used in the spinal cord injury (SCI) population. Although the global cardiac responses have been previously studied, it is unclear how either exercise influences contractile cardiac function. Here, the cardiac contractile and volumetric responses to upper-limb (swim) and passive lower-limb exercise were investigated in rodents with a severe high-thoracic SCI. Animals were divided into control (CON), SCI no exercise (NO-EX), SCI passive hindlimb cycling (PHLC), or SCI swim (SWIM) groups. Severe contusion SCI was administered at the T2 level. PHLC and SWIM interventions began on postinjury and lasted 25 days. Echocardiography and dobutamine stress echocardiography were performed before and after injury. Cardiac contractile indexes were assessed in vivo at study termination via a left ventricular pressure-volume conductance catheter. Stroke volume was reduced after SCI (91 µl in the NO-EX group vs. 188 µl in the CON group, < 0.05) and was reversed at study termination in the PHLC (167 µl) but not SWIM (90 µl) group. Rates of contraction were reduced in NO-EX versus CON groups (6,079 vs. 9,225 mmHg, respectively, < 0.05) and were unchanged by PHLC and SWIM training. Similarly, end-systolic elastance was reduced in the NO-EX versus CON groups (0.67 vs. 1.37 mmHg/µl, respectively, < 0.05) and was unchanged by PHLC or SWIM training. Dobutamine infusion normalized all pressure indexes in each SCI group (all < 0.05). In conclusion, PHLC improves flow-derived cardiac indexes, whereas SWIM training displayed no cardiobeneficial effect. Pressure-derived deficits were corrected only with dobutamine, suggesting that reduced β-adrenergic stimulation is principally responsible for the impaired cardiac contractile function after SCI. This is the first direct comparison between the cardiac changes elicited by active upper-limb or passive lower-limb exercise after spinal cord injury. Here, we demonstrate that lower-limb exercise positively influences flow-derived cardiac indexes, whereas upper-limb exercise does not. Furthermore, neither intervention corrects the cardiac contractile dysfunction associated with spinal cord injury.
Topics: Animals; Bicycling; Blood Pressure; Echocardiography, Stress; Hindlimb; Humans; Male; Myocardial Contraction; Physical Conditioning, Animal; Physical Conditioning, Human; Rats; Rats, Wistar; Regional Blood Flow; Spinal Cord Injuries; Swimming; Upper Extremity
PubMed: 28710067
DOI: 10.1152/ajpheart.00046.2017 -
Journal of Medical Case Reports Mar 2017Cardiac trauma is associated with a much higher mortality rate than injuries to other organ systems, even though cardiac trauma is identified in less than 10% of all...
BACKGROUND
Cardiac trauma is associated with a much higher mortality rate than injuries to other organ systems, even though cardiac trauma is identified in less than 10% of all trauma admissions. Here we report blunt trauma of the left atrium due to snowboarding trauma.
CASE PRESENTATION
A 45-year-old Asian man collided with a tree while he was snowboarding and drinking. He lost consciousness temporarily. An air ambulance was requested and he was transported to an advanced critical care center. On arrival, a pericardial effusion was detected by a focused assessment with sonography for trauma. His presenting electrocardiogram revealed normal sinus rhythm and complete right bundle branch block. Laboratory findings included a white blood cell count of 13.5 × 10/μl, serum creatine kinase level of 459 IU/l, and creatine kinase-myocardial band level of 185 IU/l. Enhanced computed tomography showed a large pericardial effusion and bleeding from his left adrenal gland. There were no pelvic fractures. A diagnosis of cardiac tamponade due to blunt cardiac injury and left adrenal injury due to blunt trauma was made. Subsequently, emergency thoracic surgery and transcatheter arterial embolization of his left adrenal artery were performed simultaneously. A laceration of the left atrial appendage in the lateral wall of his left ventricle was detected intraoperatively and repaired. His postoperative course progressed favorably, although a pericardial effusion was still detected on chest computed tomography on hospital day 35. His electrocardiogram showed normal sinus rhythm and the complete right bundle branch block pattern changed to a narrow QRS wave pattern. He was discharged on hospital day 40.
CONCLUSIONS
The present case report illustrates two points: (1) severe injuries resulted from snowboarding, and (2) complete right bundle branch block was caused by blunt cardiac injury. The present report showed blunt trauma of the left atrium with complete right bundle branch block as an electrocardiogram change due to snowboarding trauma. To detect cardiac trauma in snowboarding accidents, an examination of an electrocardiogram is required in all patients who might have a bruised chest.
Topics: Adrenal Glands; Cardiac Surgical Procedures; Electrocardiography; Humans; Male; Middle Aged; Myocardial Contusions; Pericardial Effusion; Skiing; Thoracic Injuries; Tomography, X-Ray Computed; Treatment Outcome; Wounds, Nonpenetrating
PubMed: 28340603
DOI: 10.1186/s13256-017-1242-2 -
BioResearch Open Access 2017Our review of real-time three-dimensional echocardiography (RT3DE) discusses the diagnostic utility of RT3DE and provides a comparison with two-dimensional... (Review)
Review
Our review of real-time three-dimensional echocardiography (RT3DE) discusses the diagnostic utility of RT3DE and provides a comparison with two-dimensional echocardiography (2DE) in clinical cardiology. A Pubmed literature search on RT3DE was performed using the following key words: transthoracic, two-dimensional, three-dimensional, real-time, and left ventricular (LV) function. Articles included perspective clinical studies and meta-analyses in the English language, and focused on the role of RT3DE in human subjects. Application of RT3DE includes analysis of the pericardium, right ventricular (RV) and LV cavities, wall motion, valvular disease, great vessels, congenital anomalies, and traumatic injury, such as myocardial contusion. RT3DE, through a transthoracic echocardiography (TTE), allows for increasingly accurate volume and valve motion assessment, estimated LV ejection fraction, and volume measurements. Chamber motion and LV mass approximation have been more accurately evaluated by RT3DE by improved inclusion of the third dimension and quantification of volumetric movement. Moreover, RT3DE was shown to have no statistical significance when comparing the ejection fractions of RT3DE to cardiac magnetic resonance (CMR). Analysis of RT3DE data sets of the LV endocardial exterior allows for the volume to be directly quantified for specific phases of the cardiac cycle, ranging from end systole to end diastole, eliminating error from wall motion abnormalities and asymmetrical left ventricles. RT3DE through TTE measures cardiac function with superior diagnostic accuracy in predicting LV mass, systolic function, along with LV and RV volume when compared with 2DE with comparable results to CMR.
PubMed: 28303211
DOI: 10.1089/biores.2016.0033 -
BMC Cardiovascular Disorders Feb 2017Blunt cardiac trauma encompasses a wide range of clinical entities, including myocardial contusion, cardiac rupture, valve avulsion, pericardial injuries, arrhythmia,...
BACKGROUND
Blunt cardiac trauma encompasses a wide range of clinical entities, including myocardial contusion, cardiac rupture, valve avulsion, pericardial injuries, arrhythmia, and even myocardial infarction. Acute myocardial infarction due to coronary artery dissection after blunt chest trauma is rare and may be life threatening. Differential diagnosis of acute myocardial infarction from cardiac contusion at this setting is not easy.
CASE PRESENTATION
Here we demonstrated a case of blunt chest trauma, with computed tomography detected myocardium enhancement defect early at emergency department. Under the impression of acute myocardial infarction, emergent coronary angiography revealed left anterior descending artery occlusion. Revascularization was performed and coronary artery dissection was found after thrombus aspiration. Finally, the patient survived after coronary stenting.
CONCLUSION
Perfusion defects of myocardium enhancement on CT after blunt chest trauma can be very helpful to suggest myocardial infarction and facilitate the decision making of emergent procedure. This valuable sign should not be missed during the initial interpretation.
Topics: Accidents, Traffic; Adult; Computed Tomography Angiography; Coronary Angiography; Coronary Occlusion; Coronary Vessels; Early Diagnosis; Electrocardiography; Heart Injuries; Humans; Male; Myocardial Infarction; Percutaneous Coronary Intervention; Predictive Value of Tests; Stents; Treatment Outcome; Wounds, Nonpenetrating
PubMed: 28183285
DOI: 10.1186/s12872-017-0496-3 -
The Journal of Tehran Heart Center Apr 2016A myocardial contusion refers to a bruise of the cardiac muscle, the severity of which can vary depending on the severity of the injury and when the injury occurs. It is... (Review)
Review
A myocardial contusion refers to a bruise of the cardiac muscle, the severity of which can vary depending on the severity of the injury and when the injury occurs. It is a major cause of rapid death which happens after blunt chest trauma and should be suspected at triage in the emergency department. We demonstrated that suspected myocardial contusion patients who have normal electrocardiograms (ECGs) and biomarker tests can be safely discharged. However, if the test results are abnormal, the next steps should be echocardiography and more advanced measures. Diagnosing myocardial contusion is very difficult because of its nonspecific symptoms. If a myocardial contusion happens, cardiogenic shock or arrhythmia must be anticipated, and the patient must be carefully monitored.
PubMed: 27928254
DOI: No ID Found -
Heart Failure Reviews Nov 2016The aim of this article is to evaluate the clinical utility of cardiac injury biomarkers in paediatric age. In December 2015, a literature search was performed (PubMed... (Review)
Review
The aim of this article is to evaluate the clinical utility of cardiac injury biomarkers in paediatric age. In December 2015, a literature search was performed (PubMed access to MEDLINE citations; http://www.ncbi.nlm.nih.gov/PubMed/ ). The search strategy included the following medical subject headings and text terms for the key words: "cardiac injury biomarkers", "creatine kinase-MB", "myoglobin", "troponin", "children", "neonate/s", "newborn/s", "infant/s" and echocardiography. In the paediatric population, troponins show a good correlation with the extent of myocardial damage following cardiac surgery and cardiotoxic medication and can be used as predictors of subsequent cardiac recovery and mortality. Elevation of cardiac injury biomarkers may also have diagnostic value in cases when cardiac contusion or pericarditis is suspected. Cardiac injury biomarkers are very sensitive markers for the detection of myocardial injury and have been studied in healthy newborns, after tocolysis, intrauterine growth restriction, respiratory distress and asphyxia. The proportion of newborns with elevated troponin was higher than that in ill infants, children, and adolescents and in healthy adults, suggesting that myocardial injury, although clinically occult, is common in this young age group. Results suggest that significant elevation of cord troponin is an excellent early predictor of severity of hypoxic-ischaemic encephalopathy and mortality in term infants. Cardiac biomarkers may also benefit centres without on-site echocardiography with evidence showing good correlation with echo-derived markers of myocardial function. Further studies are needed to better clarify the role of cardiac biomarkers in paediatric age and their correlation with echocardiographic parameters.
Topics: Adolescent; Biomarkers; Child; Child, Preschool; Creatine Kinase, MB Form; Fetal Blood; Heart Diseases; Humans; Infant; Infant, Newborn; Myocardium; Myoglobin; Pediatrics; Troponin
PubMed: 27255332
DOI: 10.1007/s10741-016-9567-2 -
PloS One 2016Cardiac trauma has been recognized as a complication associated with blunt chest trauma involving coronary artery injury, myocardium contusion and myocardial rupture....
Cardiac trauma has been recognized as a complication associated with blunt chest trauma involving coronary artery injury, myocardium contusion and myocardial rupture. Secondary cardiac injuries after trauma supposed to be a critical factor in trauma patients, but the mechanism is not fully explored. Overproduction of TNF-alpha had been reported in multiple trauma animals, this induces oxidative stress resulting in cardiac apoptosis. Apoptosis gradually increases after trauma and reaches to a maximum level in 12 h time. TNF-alpha increases the expression of NFkB, and induces the expression of caspase-3 and resulted in cell apoptosis. The effect can be attenuated by non-selective caspase inhibitor and IL10. Fas induced cardiac apoptosis and hypertrophy in ischemic heart disease. In this study, we demonstrated a trauma-hemorrhagic shock (THS) model in rats and resuscitated rats by lactated Ringer's (L/R) solution after shock in different hours (0 hour, 4 hours, 8 hours). NFkB gradually increased after the first 8 hours of shock, and can be reduced by fluid resuscitation. NFkB is known as a downstream pathway of Fas related apoptosis, we found Fas ligand, caspase-8 levels elevate after shock, and can be reduced by resuscitation. In addition, resuscitation can activate insulin-like growth factor (IGF-1)/Akt pathway, at the same time. It can block mitochondrial damage by decrease the effect of tBid. In conclusion, THS can induce secondary cardiac injury. Fas showed to be an important element in caspase cascade induced myocardium apoptosis. By L/R fluid resuscitation, the suppression of caspase cascade and activation of IGF-I/Akt pathway showed antiapoptotic effects in traumatic heart of rats.
Topics: Animals; Apoptosis; Caspase 3; Caspase 8; Cytochromes c; Disease Models, Animal; Fas Ligand Protein; Fluid Therapy; Insulin-Like Growth Factor I; Isotonic Solutions; Male; Myocytes, Cardiac; NF-kappa B; Proto-Oncogene Proteins c-akt; Rats; Rats, Sprague-Dawley; Resuscitation; Ringer's Lactate; Shock, Hemorrhagic; Tumor Necrosis Factor-alpha; fas Receptor
PubMed: 27780234
DOI: 10.1371/journal.pone.0165406 -
Medicine Sep 2016Cardiac rupture often occurs after myocardial infarction or chest trauma with a high mortality rate. However, left ventricular rupture caused by radiofrequency catheter...
BACKGROUND
Cardiac rupture often occurs after myocardial infarction or chest trauma with a high mortality rate. However, left ventricular rupture caused by radiofrequency catheter ablation (RFCA) is extremely rare.
METHODS
We describe a case of a 61-year-old male who survived from left ventricular rupture caused by a RFCA procedure for frequent ventricular premature contractions. Surgical exploration with cardiopulmonary bypass (CPB) was performed when the signs of cardiac tamponade developed 7 hours after the ablation surgery.
RESULTS
Teflon-buttressed sutures of the tear in the left ventricular posterolateral wall and pericardium patch applied to the contusion region on the wall repaired the rupture safely and effectively.
CONCLUSION
Timely surgical intervention under CPB facilitated the survival of the patient. Teflon-buttressed sutures plus pericardium patch achieved the successful repair of the rupture.
Topics: Cardiac Surgical Procedures; Cardiac Tamponade; Cardiopulmonary Bypass; Catheter Ablation; Heart Ventricles; Humans; Male; Middle Aged; Pericardium; Polytetrafluoroethylene; Sutures; Ventricular Septal Rupture
PubMed: 27661047
DOI: 10.1097/MD.0000000000004933