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Cardiac injury complicating traumatic asphyxia
R M Rosato1, M J Shapiro, M J Keegan
1Department of Surgery, St. Louis University Medical Center, MO 63110-0250.
Insights
Traumatic asphyxia, a rare condition, can cause significant cardiac injury, including ventricular rupture. A comprehensive cardiac evaluation is crucial for patients with traumatic asphyxia.
Area of Science:
- Trauma Surgery
- Cardiology
- Emergency Medicine
Background:
- Traumatic asphyxia is a rare clinical syndrome resulting from severe blunt force trauma to the chest.
- Fewer than 200 cases have been reported globally, with limited documentation of associated cardiac injuries.
Observation:
- A 3-year study at St. Louis University Medical Center identified 8 patients with traumatic asphyxia.
- Common causes included motor vehicle collisions, elevator accidents, and industrial accidents involving heavy machinery.
- Associated injuries encompassed pulmonary contusions, hemopneumothorax, and various fractures.
Findings:
- 37.5% of patients (3 out of 8) exhibited cardiac injuries.
- These included two cases of cardiac contusion and one case of ventricular rupture.
- One fatality occurred in a patient with a ruptured right ventricle and extensive abdominal injuries.
Implications:
- This case series highlights the significant incidence of cardiac injury in traumatic asphyxia.
- Complete cardiac assessment, including enzyme levels, ECG, and echocardiography, is essential for these patients.
- Early recognition and management of cardiac complications can improve patient outcomes.
Abstract:
During a 3-year period (1986-1989), 8 patients were seen at St. Louis University Medical Center exhibiting the stigmata of traumatic asphyxia. Fewer than 200 cases of traumatic asphyxia have been reported and there is only a single report of a cardiac injury. In this series, 3 of 8 (37.5%) patients were found to have an injury to the heart: two cardiac contusions and a ventricular rupture. Five patients were crushed in motor vehicle collisions, one by an elevator counterweight, and two patients by river barges. Injuries associated with these patients include pulmonary contusion, hemopneumothorax, traumatic pneumatocele, traumatic retinopathy, bone fractures, mental confusion, and liver contusion. There was one death in the series, a patient with rupture of the right ventricle and severe splenic and liver injuries. The cardiac status of the patients was evaluated by serial serum cardiac enzyme determinations, electrocardiograms, and echocardiography. This report illustrates the importance of complete cardiac evaluation in patients with traumatic asphyxia.