TRAUMATIC HEART DISEASE

DR. JAYANTA KR GOGOI

CAUSE

PENETRATINGBLUNT TRAUMAIATROGENICMETABOLICOTHER

PENETRATING CARDIAC INJURY Stab wounds Gunshot wounds Shotgun wounds

Penetrating cardiac injury Location: anterior chest wall

RV/LV RA LA Complex injury

C/FAsymptomatic to

Cardiac arrest

80 % of stab wound

temponade

BECK’S TRIAD

Muffled heart sounds Hypotension Distended neck veins

Others Pulsus paradoxus Kussmaul’s sign

Gunshot

20%

80%

Cardiac injurytemponade hemorrhage

Evaluation

High index of suspicion ER– ABC

iv access CXR FAST Look for clinical signs

Treatment

Observation Emergency

thoracotomy Definitive repair

Surgical exploration

Anterior or medial thoracotomy

AimRelief temponade

Hemorrhage controlCorrection of acidosis

Hypothermiaresuscitation

Left anterolateral thoracotomy

left anterolateral thoracotomy

Access:• pericardium and heart •exposure for aortic-cross clamping

Cardiorrhaphy

•Delayed sequelae•CABG may be required•Valve surgery may be required

Survival rate

STAB WOUND GUN SHOT

30% 30%

90%

40%

Chart TitleSeries 1 Series 2

Blunt trauma

Presentation

Free wall rupture Coronary artery thrombosis Cardiac failure Arrhythmia Rupture cordae and PM

Blunt trauma is more dangerous Direct transmission of pressure Hydraulic effect– RA Contusion Atrio-caval tear

C/F• Temponade• Hemorrhage

• Dysarrhythmia

Evaluation

ER management ECG:

Conduction disturbances are more common

Cardiac enzymes Echocardiography

Treament

Asymptomatic – observation Symptomatic – surgical exploration

and repair

Cardiac rupture worst prognosis Only 20% survive

Iatrogenic cardiac injury

Central venous line Cardiac catheterization

Coronary A. rupture Aortic dissection

Pericardiocentesis Pericardial window CPR

Treatment

Temponade– Pericardiocentesis Subxiphoid window

Intracardiac foreign body Bullets Explosive and missiles fragments Hypodermic needle

Complication

•Acute suppurative pericarditis•CCP•FB reaction•heamopericardium

Treatment

Left sided FB 1-2 cm sized Rough edged Symptom producing

•Endovascular technique•Bypass

Metabolic injury and burn

Post resuscitation injury Burn etc Chemical mediators

Endotoxin Cytokines TNF IL-1, 6, 10 Epi, NA CAMs NO

•Conduction disturbance•Decreased contractility•Low CO

C/F

Treatment

Supportive treatment

Thank you….