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Blunt cardiac rupture: the utility of emergency department ultrasound
N P Symbas1, P F Bongiorno, P N Symbas
1Department of Surgery, Grady Hospital, Emory University School of Medicine, Atlanta, Georgia 30303, USA.
Insights
Cardiac rupture from blunt trauma is often fatal, but prompt diagnosis and surgical repair can improve survival. This case series highlights successful outcomes with immediate ultrasound and primary repair, even without cardiopulmonary bypass.
Area of Science:
- Trauma Surgery
- Emergency Medicine
- Cardiology
Background:
- Cardiac rupture is a severe, often fatal, consequence of blunt trauma.
- Prompt diagnosis and treatment are critical for survival in patients who reach the emergency department alive.
Observation:
- Four consecutive patients with free cardiac wall rupture due to motor vehicle accidents were treated.
- Diagnoses were established via ultrasound (3 patients) or exploratory surgery (1 patient).
- All cardiac tears were repaired surgically without cardiopulmonary bypass.
Findings:
- Three out of the four patients survived the cardiac rupture repair.
- The study involved tears of the right ventricle, right atrium, and left atrium.
Implications:
- Increased prehospital care and transport may lead to more patients presenting with cardiac rupture.
- Physicians must maintain a high index of suspicion for cardiac rupture in blunt trauma.
- Immediate ultrasonography and prompt surgical intervention are key to improving survival rates for cardiac rupture.
Background:
Rupture of the heart is usually a fatal injury in patients sustaining blunt trauma. Those arriving in the emergency department alive can be saved with prompt diagnosis and treatment.
Methods:
We describe the cases of 4 consecutive patients with rupture of the free cardiac wall whom we treated at Grady Hospital. Two had a tear of the right ventricle, 1 had a tear of the right atrium, and 1 had two tears of the left atrium. All patients were involved in motor vehicle accidents. The diagnosis was made by ultrasound in 3 patients and during exploratory surgical intervention in the other. All tears were repaired primarily without the aid of cardiopulmonary bypass.
Results:
Three of the patients survived, and 1 died.
Conclusions:
Rarely are patients with rupture of the free cardiac wall seen in an emergency department. The improvements in the prehospital care and the transportation may result in an increase in the numbers of such patients. Physicians treating patients with blunt trauma must suspect the presence of cardiac rupture. Immediate use of ultrasonography will establish the diagnosis and prompt repair of the injury may improve overall survival.