RT Book, Section
A1 Ferguson, Jr., T. Bruce
A2 Fuster, Valentin
A2 Harrington, Robert A.
A2 Narula, Jagat
A2 Eapen, Zubin J.
SR Print(0)
ID 1191188693
T1 TRAUMATIC HEART DISEASE
T2 Hurst's The Heart, 14e
YR 2017
FD 2017
PB McGraw-Hill Education
PP New York, NY
SN 9780071843249
LK accessmedicine.mhmedical.com/content.aspx?aid=1191188693
RD 2024/04/19
AB SummaryThis  chapter  discusses  traumatic  injury  to  the  heart  and  the  great  vessels.  Thoracic  injuries  are  a  contributing  factor  in  up  to  75%  of  all  trauma-related  deaths.  Causes  of  traumatic  cardiovascular  injury  can  be  broadly  classified  into  having  arisen  from  penetrating  or  blunt  mechanisms  (see  accompanying  Hurst’s  Central  Illustration).  Penetrating  injuries  to  the  heart  and  great  vessels  are  associated  with  high  mortality;  early  diagnosis  is  critical  for  survival  and  penetrating  cardiovascular  injuries  should  therefore  be  suspected  with  any  missile  or  knife  wound  to  the  thorax  or  upper  abdomen.  Repair  is  often  performed  through  a  left  thoracotomy  in  the  emergency  department.  If  patients  with  a  penetrating  heart  injury  are  sufficiently  stable,  a  median  sternotomy  in  the  operating  room  is  preferred.  Blunt  injury  requires  significant  force,  such  as  occurs  in  motor  vehicle  crashes  or  falls  from  heights.  Diagnosis  of  blunt  trauma  to  the  heart  can  be  difficult,  because  a  majority  of  patients  are  asymptomatic.  In  cases  of  blunt  heart  injury  with  severe  ventricular  dysfunction  and  low  cardiac  output,  inotropic  support  is  appropriate  and,  if  no  satisfactory  improvement  occurs,  intra-aortic  balloon  counterpulsation  should  be  considered.  Emergency  surgical  intervention  via  sternotomy  is  mandatory  for  pericardial  rupture.  Management  options  for  blunt  trauma  to  the  great  vessels  include  immediate  repair  through  a  left  thoracotomy,  delayed  repair  in  multiply  injured  patients  requiring  ongoing  resuscitation,  or  endovascular  stent  graft  insertion  in  selected  patients.