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Ulusal Travma Ve Acil Cerrahi Dergisi =... May 2022The objective of the study is to investigate diagnostic and clinical processes performed for cardiac contusion in patients with blunt thoracic trauma.
BACKGROUND
The objective of the study is to investigate diagnostic and clinical processes performed for cardiac contusion in patients with blunt thoracic trauma.
METHODS
This study was conducted retrospectively on 65 patients admitted with isolated blunt thoracic trauma to the Emergency Medicine Department. The CT images, the cardiac enzyme levels, the periodic 4-h follow-up electrocardiography (ECGs) in the emer-gency department, and the results of echocardiography, performed at admission and when required according to the clinical status, were investigated. The 1-h and 4-h high-sensitivity troponin I levels were studied, and values above 0.04 ng/ml were considered as positive.
RESULTS
Sixty-five patients with isolated thoracic trauma were included in the study, 23 (35.38%) had pulmonary and cardiac contu-sions both. In 23 (35.38%) patients, pulmonary contusion had been present, and cardiac contusion had not been identified at the initial evaluation. However, during clinical follow-up, troponin became positive, dysrhythmia developed, and the trauma affected the heart in four of these patients. In six (9.24%) patients, cardiac contusion was identified without pulmonary contusion. In 13 (20%) patients, no cardiac or pulmonary contusion was identified. troponin elevation was detected in 10 patients without a diagnosis of cardiac contusion who had a pulmonary contusion, hemothorax, and/or pneumothorax at the time of hospital admission and then with normal troponin levels at 4-h control. We found that there was a statistical agreement between cardiac contusion and troponin-ECG results at 4th h.
CONCLUSION
We advise that all blunt thoracic trauma patients should be screened for cardiac contusion by continuous ECG monitoring and troponin levels.
Topics: Attention; Contusions; Humans; Lung Injury; Myocardial Contusions; Retrospective Studies; Thoracic Injuries; Troponin I; Wounds, Nonpenetrating
PubMed: 35485460
DOI: 10.14744/tjtes.2021.11290 -
Journal of the American College of... Mar 2023Causes and precipitating factors of sudden cardiac death (SCD) in adolescents are poorly understood.
BACKGROUND
Causes and precipitating factors of sudden cardiac death (SCD) in adolescents are poorly understood.
OBJECTIVES
The authors sought to investigate the etiologies of SCD and their association with physical activity in a large cohort of adolescents.
METHODS
Between 1994 and June 2022, 7,675 cases of SCD were consecutively referred to our national cardiac pathology center; 756 (10%) were adolescents. All cases underwent detailed autopsy evaluation by expert cardiac pathologists. Clinical information was obtained from referring coroners.
RESULTS
A structurally normal heart, indicative of sudden arrhythmic death syndrome was the most common autopsy finding (n = 474; 63%). Myocardial diseases were detected in 163 cases (22%), including arrhythmogenic cardiomyopathy (n = 36; 5%), hypertrophic cardiomyopathy (n = 31; 4%), idiopathic left ventricular hypertrophy (n = 31; 4%), and myocarditis (n = 30; 4%). Coronary artery anomalies were identified in 17 cases (2%). Decedents were competitive athletes in 128 cases (17%), and 159 decedents (21%) died during exercise. Arrhythmogenic cardiomyopathy was diagnosed in 8% of athletes compared with 4% of nonathletes (P = 0.05); coronary artery anomalies were significantly more common in athletes (9% vs 1%; P < 0.001), as well as commotio cordis (5% compared with 1% in nonathletes; P = 0.001). The 3 main comorbidities were asthma (n = 58; 8%), epilepsy (n = 44; 6%), and obesity (n = 40; 5%).
CONCLUSIONS
Sudden arrhythmic death syndrome and myocardial diseases are the most common conditions diagnosed at autopsy in adolescent victims of SCD. Among causes of SCD, arrhythmogenic cardiomyopathy, coronary artery anomalies, and commotio cordis are more common in young athletes than in similar age sedentary individuals.
Topics: Humans; Adolescent; Commotio Cordis; Death, Sudden, Cardiac; Athletes; Cardiomyopathies; United Kingdom; Coronary Artery Disease
PubMed: 36922085
DOI: 10.1016/j.jacc.2023.01.041 -
World Journal of Emergency Surgery :... May 2023The diagnosis of cardiac contusion, caused by blunt chest trauma, remains a challenge due to the non-specific symptoms it causes and the lack of ideal tests to diagnose... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
The diagnosis of cardiac contusion, caused by blunt chest trauma, remains a challenge due to the non-specific symptoms it causes and the lack of ideal tests to diagnose myocardial damage. A cardiac contusion can be life-threatening if not diagnosed and treated promptly. Several diagnostic tests have been used to evaluate the risk of cardiac complications, but the challenge of identifying patients with contusions nevertheless remains.
AIM OF THE STUDY
To evaluate the accuracy of diagnostic tests for detecting blunt cardiac injury (BCI) and its complications, in patients with severe chest injuries, who are assessed in an emergency department or by any front-line emergency physician.
METHODS
A targeted search strategy was performed using Ovid MEDLINE and Embase databases from 1993 up to October 2022. Data on at least one of the following diagnostic tests: electrocardiogram (ECG), serum creatinine phosphokinase-MB level (CPK-MB), echocardiography (Echo), Cardiac troponin I (cTnI) or Cardiac troponin T (cTnT). Diagnostic tests for cardiac contusion were evaluated for their accuracy in meta-analysis. Heterogeneity was assessed using the I and the QUADAS-2 tool was used to assess bias of the studies.
RESULTS
This systematic review yielded 51 studies (n = 5,359). The weighted mean incidence of myocardial injuries after sustaining a blunt force trauma stood at 18.3% of cases. Overall weighted mean mortality among patients with blunt cardiac injury was 7.6% (1.4-36.4%). Initial ECG, cTnI, cTnT and transthoracic echocardiography TTE all showed high specificity (> 80%), but lower sensitivity (< 70%). TEE had a specificity of 72.1% (range 35.8-98.2%) and sensitivity of 86.7% (range 40-99.2%) in diagnosing cardiac contusion. CK-MB had the lowest diagnostic odds ratio of 3.598 (95% CI: 1.832-7.068). Normal ECG accompanied by normal cTnI showed a high sensitivity of 85% in ruling out cardiac injuries.
CONCLUSION
Emergency physicians face great challenges in diagnosing cardiac injuries in patients following blunt trauma. In the majority of cases, joint use of ECG and cTnI was a pragmatic and cost-effective approach to rule out cardiac injuries. In addition, TEE may be highly accurate in identifying cardiac injuries in suspected cases.
Topics: Humans; Thoracic Injuries; Wounds, Nonpenetrating; Heart Injuries; Myocardial Contusions; Troponin I; Troponin T; Diagnostic Tests, Routine
PubMed: 37245048
DOI: 10.1186/s13017-023-00504-9 -
Cureus Dec 2022Lightning strikes are frequently encountered and are a major cause of morbidity and mortality. It could impair several organs, but the effects of electric current on...
Lightning strikes are frequently encountered and are a major cause of morbidity and mortality. It could impair several organs, but the effects of electric current on the cardiovascular system contribute to the primary cause of cardiorespiratory arrest. These effects can be either transient or persistent, ranging from benign or life-threatening arrhythmias, ischemic injury, myocardial contusion, aortic injury, cardiomyopathy, and ventricular failure. Myocarditis has been an important but not very well-understood cause of cardiac dysfunction. Fulminant myocarditis is defined as patients presenting with severe heart failure, having a duration of <2 weeks of symptoms, and requiring inotropic or mechanical circulatory support. This condition can rapidly lead to hemodynamic instability and death. Resuscitation for a longer time increases the probability of favorable outcomes in young and previously healthy patients. This case report accounts for a case of a healthy young male who was struck by lightning while working on the farm and developed electrocardiographic changes along with positive cardiac biomarkers.
PubMed: 36644050
DOI: 10.7759/cureus.32443 -
Critical Care and Resuscitation :... Mar 2005To utilise an evidence-based strategy to answer two clinical questions regarding myocardial contusion - How is the diagnosis made and how long does a patient require...
OBJECTIVE
To utilise an evidence-based strategy to answer two clinical questions regarding myocardial contusion - How is the diagnosis made and how long does a patient require cardiac monitoring?
METHODS
Pubmed search using appropriate MeSH terminology then selection of abstracts using a predetermined criteria.
RESULTS
One meta-analysis, five descriptive reviews and thirty-two other articles were selected for detailed review.
CONCLUSION
Myocardial contusion is an ill-defined term for traumatic cardiac injury. "Significant blunt chest trauma" appears to be a more useful term. Normal serially performed electrocardiograms and troponin I assays over 8 hours appear to exclude this condition. When complications occur, the onset is usually within 48 hours of injury. Monitoring of patients with abnormal ECG's or troponins for at least 48 hours post injury would therefore be prudent.
PubMed: 16548816
DOI: No ID Found -
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 -
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 -
Journal of Cardiothoracic Surgery Feb 2023Blunt cardiac injury (BCI) encompasses a spectrum of pathologies ranging from clinically silent, transient arrhythmias to deadly cardiac wall rupture. Of diagnosed BCIs,... (Review)
Review
Blunt cardiac injury (BCI) encompasses a spectrum of pathologies ranging from clinically silent, transient arrhythmias to deadly cardiac wall rupture. Of diagnosed BCIs, cardiac contusion is most common. Suggestive symptoms may be unrelated to BCI, while some injuries may be clinically asymptomatic. Cardiac rupture is the most devastating complication of BCI. Most patients who sustain rupture of a heart chamber do not reach the emergency department alive. The incidence of BCI following blunt thoracic trauma remains variable and no gold standard exists to either diagnose cardiac injury or provide management. Diagnostic tests should be limited to identifying those patients who are at risk of developing cardiac complications as a result of cardiac in jury. Therapeutic interventions should be directed to treat the complications of cardiac injury. Prompt, appropriate and well-orchestrated surgical treatment is invaluable in the management of the unstable patients.
Topics: Humans; Heart Injuries; Heart; Myocardial Contusions; Heart Rupture; Wounds, Nonpenetrating; Rupture; Thoracic Injuries
PubMed: 36765392
DOI: 10.1186/s13019-023-02146-z -
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 -
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