Traumatic tricuspid valve rupture presenting as third-degree atrioventricular block

Cardiac valve injury after blunt chest trauma is extremely rare, and the tricuspid valve is most commonly affected because of the anterior location of the right ventricle. Tricuspid valve insufficiency can range from a subclinical presentation to acute cardiac failure.

Diagnosis is difficult in trauma patients because hypotension is usually attributed to hemorrhage and anatomical cardiac injuries might be overlooked.

This is a case of a 70-year-old patient with a history of rheumatic heart disease who suffered a complete rupture of her papillary muscles leading to tricuspid insufficiency after a motor vehicle collision. She presented with third-degree atrioventricular block.

Consideration of screening for anatomical heart injuries in blunt trauma patients with new onset dysrhythmias is recommended to explain hypotension not attributable to hemorrhage.