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Shockwave cardiac injury in thoracoabdominal gunshot wound
Weludo Ngwisanyi1, Shirley F A P Moeng1, Maeyane Moeng1
1Department of Surgery, University of the Witwatersrand, South Africa.
Insights
Non-penetrating cardiac injuries from gunshot wounds are difficult to diagnose and can lead to delayed presentation and poor outcomes. Early suspicion and thorough investigation are crucial for timely diagnosis and management of these critical cardiac injuries.
Area of Science:
- Trauma Surgery
- Cardiology
- Emergency Medicine
Background:
- Penetrating cardiac injuries have high mortality but are typically diagnosed and managed promptly.
- Non-penetrating cardiac injuries, particularly in stable patients, are often overlooked, leading to diagnostic challenges and delayed treatment.
- Clinicians must maintain a high index of suspicion for cardiac injuries when wound trajectories are near the heart.
Observation:
- Two cases of young males sustaining gunshot wounds to the thoracoabdomen with associated non-perforating cardiac injuries are presented.
- The first case illustrates a fatal outcome due to co-existing severe injuries.
- The second case demonstrates potential late complications following initial management of non-penetrating cardiac injury.
Findings:
- Shock wave injury, a form of non-penetrating cardiac injury, can result from high-velocity projectiles near the heart or pericardium.
- Comprehensive history, physical examination, and serial imaging studies are vital for diagnosing cardiac shock wave injuries.
- Early detection of subtle changes through serial investigations is essential.
Implications:
- Timely diagnosis and management of all cardiac injuries are critical to reduce high morbidity and mortality rates.
- Increased awareness and diagnostic vigilance are necessary to prevent delayed presentations and improve patient outcomes.
- Effective management strategies are paramount for improving survival rates in patients with cardiac trauma.
Introduction And Importance:
Cardiac injuries are associated with high mortality rates and most affected individuals succumb to their injuries before arrival to the hospital. Even though they have a higher fatality rate, penetrating cardiac injuries are relatively easy to diagnose and they have straightforward management protocols. On the other hand unexpected non-penetrating cardiac injuries, especially in haemodynamically stable patients, are not looked out for and can be difficult to diagnose. They may have a delayed presentation leading to poor patient outcomes. Clinicians should have a high index of suspicion when wound paths are in the vicinity of the heart, to avoid missing early signs and possibly prevent late presentation of these injuries.
Case Presentation:
Two previously well male patients aged 29 and 33 years old respectively, sustained gunshot wounds to the thoracoabdomen which in each case became associated with non perforating cardiac injuries. The first case highlighted the unfortunate end of these uncommon injuries when there are other serious injuries present. The second case illustrated possibility of late complications even after management of non-penetrating cardiac injury.
Clinical Discussion:
In these cases, shock wave injury refers to non penetrating cardiac injury induced by high a voltage bullet in proximity to the heart/pericardium. A thorough history and examination in addition to multiple investigational modalities should be performed in order to exclude cardiac shockwave injuries. In some instances serial imaging studies are needed to detect the earliest changes associated with these injuries.
Conclusion:
Cardiac injuries carry a high morbidity and mortality and therefore a timeous diagnosis and management of these injuries is essential to prevent fatalities.