RT Book, Section A1 Ferguson, Jr, T. Bruce A1 Rogers, Austin A1 Allman, Robert A2 Fuster, Valentin A2 Narula, Jagat A2 Vaishnava, Prashant A2 Leon, Martin B. A2 Callans, David J. A2 Rumsfeld, John S. A2 Poppas, Athena SR Print(0) ID 1202453671 T1 Traumatic Heart Disease T2 Fuster and Hurst's The Heart, 15e YR 2022 FD 2022 PB McGraw-Hill Education PP New York, NY SN 9781264257560 LK accessmedicine.mhmedical.com/content.aspx?aid=1202453671 RD 2024/03/29 AB Chapter SummaryThis chapter discusses the diagnosis and management of traumatic heart disease. Traumatic thoracic injuries contribute to 75% of trauma-related deaths. These injuries are primarily from gunshot wounds and motor vehicle accidents. Penetrating cardiac injuries, in particular, are associated with high mortality. The American Association for the Surgery of Trauma Organ Injury Scale-Cardiac Surgery (AAST-OIS-CI) provides a description of cardiac injuries, where the increasing grade of injury is associated with increasing mortality. Echocardiography has replaced pericardial window as the gold standard for diagnosing cardiac injury (Focused Assessment by Sonography in Trauma [FAST]) (see Fuster and Hurst’s Central Illustration). A left anterior thoracotomy in the emergency department is the approach of choice in hemodynamically unstable patients; stable patients are more appropriate for transport to the operating room for median sternotomy. The diagnosis of blunt cardiac injury is difficult. Electrocardiography may show nonspecific ST and T wave changes, and echocardiography may show regional wall motion abnormalities or structural defects. Management of these injuries is usually expectant. Long-term follow-up is required of significant cardiac injuries. Blunt aortic injury has a high death rate at the time of injury, but 70% of patients who survive to the hospital in stable condition can survive. Thoracic endovascular aortic repair has become the standard of care for treating blunt aortic injury.