Myocardial contusion: emergency investigation and diagnosis.
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Cardiac contusion is an infrequent but occasionally serious complication of deceleration injury. According to ATLS teaching, the true diagnosis of contusion can only be established by direct inspection of the myocardium. The clinically important sequelae of myocardial contusion are hypotension and arrhythmia. Despite recent advances in investigative techniques, myocardial trauma remains an important diagnostic and management challenge. This paper presents an evidence-based review of the topic. (+info)
Histochemical study of transmyocardial laser channels in dogs.
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OBJECTIVE: Laser-induced myocardial injury was investigated in a canine transmyocardial laser revascularization model. METHODS: A total of 23 channels were created in the left ventricles of 5 animals with a CO2 laser. Four animals were sacrificed immediately and one at week 2. Lactate dehydrogenase and succinate dehydrogenase in channel regions were examined with a Nitro-BT method staining. RESULTS: Immediately after the procedure, laser channels and surrounding injured myocardium could be stratified from the center to the border into 5 concentric zones, i.e., vaporized zone, carbonized zone, enzyme-disappeared zone, enzyme-decreased zone and enzyme-concentrated zone. Two weeks later, the phenomenon disappeared. CONCLUSIONS: Immediately after transmyocardial revascularization, there is a ring of enzyme-concentrated zone at the outermost region of injured myocardium. Two weeks later, enzyme activities of reversibly injured myocytes appear to have recovered. (+info)
Traumatic ventricular septal defect and mitral insufficiency after a Kebab's shish wound to the chest.
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Transthoracic echocardiography has an important role in the assessment of patients with penetrating chest trauma. We report the case of 19-year-old boy who sustained a kebab's shish wound to the chest. Transthoracic echocardiography revealed a defect in the interventricular septum and a defect in the anterior mitral valve. Both of them were closed with direct sutures. (+info)
An expanding role for cardiopulmonary bypass in trauma.
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OBJECTIVES: To analyze experience at the McGill University Health Centre with cardiopulmonary bypass (CPB) in trauma, complemented by a review of the literature to define its role globally and outline indications for its expanded use in trauma management. DATA SOURCES: All available published English-language articles from peer reviewed journals, located using the MEDLINE database. Chapters from relevant, current textbooks were also utilized. STUDY SELECTION: Nine relevant case reports, original articles or reviews pertaining to the use of CPB in trauma. DATA EXTRACTION: Original data as well as authors' opinions pertinent to the application of CPB to trauma were extracted, incorporated and appropriately referenced in our review. DATA SYNTHESIS: Overall mortality in the selected series of CPB used in the trauma setting was 44.4%. Four of 5 survivors had CPB instituted early (first procedure in operative management) whereas 3 of 4 deaths involved late institution of CPB. CONCLUSIONS: Although CPB has traditionally been used in the setting of cardiac trauma alone, a better understanding of its potential benefit in noncardiac injuries will likely make for improved outcomes in the increasingly diverse number of severely injured patients seen in trauma centres today. Further studies by other trauma centres will allow for standardized indications for the use of CPB in trauma. (+info)
Functional and analytical evidence for scavenging of oxygen radicals by L-arginine.
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L-Arginine, the substrate of nitric oxide synthase, is known to exert favorable effects in the prevention and treatment of cardiovascular diseases. In several conditions, including atherosclerosis and ischemia/reperfusion, where oxygen metabolites are thought to mediate endothelial and myocardial injury, L-arginine has protective effects. Here we studied the mechanisms by which L-arginine protects against oxygen radical-induced myocardial injury. Buffer-perfused rat hearts were subjected to oxygen radicals generated by electrolysis or to hypoxanthine and xanthine oxidase, which generates superoxide anions (O(2)). Both sources of radicals impaired myocardial contractility, whereas L-arginine prevented the impairment. The observation that D-arginine as well as nitric oxide synthase inhibitors, such as N(G)-nitro-L-arginine but not glycine, had similar cardioprotective effects indicated that the protection might be due to a direct chemical interaction of L-arginine and its derivatives with oxygen radicals. In support, L-arginine and the derivatives prevented the formation of O(2) as determined by sensitive standard methods, whereas glycine did not. The radical scavenging activity of L-arginine and derivatives was dose-dependent, with an apparent rate constant of approximately 4.8 x 10(3) M s(-1) for the reaction of L-arginine with O(2) as determined by electron paramagnetic resonance spectroscopy using 1-hydroxy-2,2,6,6-tetramethyl-4-oxo-piperidine (TEMPONE-H) as spin trap. In summary, the results of this study demonstrate protective effects of L-arginine against oxygen radical-induced cardiac injury by free radical scavenging. (+info)
Prognostic implication of cardiac troponin T increase following stent implantation.
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OBJECTIVE: To identify the incidence and clinical significance of myocardial injury following elective stent implantation. DESIGN: Prospective clinical study with 278 consecutive patients undergoing stenting of de novo coronary or saphenous vein graft lesions. Incidence of periprocedural myocardial injury was assessed by analysis of 12 lead ECG, creatine kinase (CK; upper limit of normal (ULN) 70 IU/l for women, 80 IU/l for men), and cardiac troponin T (cTnT; point of care test; threshold 0.1 ng/ml) before and 6, 12, and 24 hours after the intervention. Major adverse cardiac events (MACE: acute myocardial infarction, bypass surgery, and cardiac death) were recorded during clinical follow up (mean (SD) 7.8 (5.3) months). RESULTS: Following elective stenting, the rate of a positive cTnT status was 17.3%, the rate of CK increase of 1-3x ULN 14.7%, the rate of CK increase of > 3x ULN 1.4%, and the rate of Q wave myocardial infarction 0.4%. Cardiac mortality during follow up was higher in patients with postprocedurally increased CK (7.1% v 1.3%, p = 0.01, log rank) and cTnT (9.1% v 0.9%, p < 0.001, log rank). In addition, postprocedurally increased cTnT was associated with a higher overall incidence of MACE (13.1% v 4.0%, p < 0.01, log rank) and was identified as an independent factor for MACE during follow up (hazard ratio 3.27, 95% confidence interval 1.14 to 9.41, p = 0.028). CONCLUSIONS: Following elective stent implantation, a positive cTnT status identified patients at risk of a worse long term outcome. Treatment strategies have to be developed that lead to prognostic improvement by reducing periprocedural myocardial injury. (+info)
Outcome of major cardiac injuries at a Canadian trauma center.
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BACKGROUND: Canadian trauma units have relatively little experience with major cardiac trauma (disruption of a cardiac chamber) so injury outcome may not be comparable to that reported from other countries. We compared our outcomes to those of other centers. METHODS: Records of patients suffering major cardiac trauma over a nine-year period were reviewed. Factors predictive of outcome were analyzed. RESULTS: Twenty-seven patients (11 blunt and 16 penetrating) with major cardiac trauma were evaluated. Injury severity scores (ISS) were similar for blunt (49.6 +/- 16.6) and penetrating (39.5 +/- 21.6, p = 0.20) injuries. Five of 11 blunt trauma patients, and 9 of 16 penetrating trauma patients, had detectable vital signs on hospital arrival (p = 0.43). Ten patients underwent emergency department thoracotomy and 11 patients had cardiac repair in the operating theatre. Eleven patients survived and 16 died. Survivors had a lower ISS (33.7 +/-15.4) than non-survivors (50.4 +/- 20.4; p = 0.03). Two of 11 blunt trauma patients and 9 of 16 penetrating trauma patients survived (p = 0.06). Eleven of 14 patients with detectable vital signs survived; all 13 without detectable vital signs died (p = 0.00003). Ten of eleven patients treated in the operating theatre survived, while only one of the other 16 patients survived (p = 0.00002). CONCLUSIONS: Patients with major cardiac injuries and detectable vital signs on hospital arrival can be salvaged by prompt surgical intervention in the operating theatre. Major cardiac injuries are infrequently encountered at our center but patient survival is comparable to that reported from trauma units in other countries. (+info)
Immunological analysis of pleural fluid in post-cardiac injury syndrome.
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Post-cardiac injury syndrome (PCIS) is an inflammatory process involving pleura and pericardium secondary to cardiac injury. Even though this clinical entity has been recognised for decades, diagnosis is difficult because of lack of a diagnostic test. Antimyocardial antibody titre in pleural fluid and serum has been proposed to have diagnostic value. However there are inherent difficulties in measuring and interpreting the role of antimyocardial antibody. A case of PCIS with low pleural fluid complement level is reported, which it is believed can be useful to support the diagnosis of PCIS. (+info)