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Anatomy of the Heart01:27

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The human heart is made up of three layers of tissue that are surrounded by the pericardium, a membrane that protects and confines the heart. The outermost layer, closest to the pericardium, is the epicardium. The pericardial cavity separates the pericardium from the epicardium. Beneath the epicardium is the myocardium, the middle layer, and the endocardium, the innermost layer. There are four chambers of the heart: the right atrium, the right ventricle, the left atrium, and the left ventricle.
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Dilated cardiomyopathy, or DCM, is a progressive myocardial disorder characterized by ventricular chamber dilation and contractile dysfunction.EtiologyVarious factors can cause DCM, including hypertension and heavy alcohol intake, which contribute to the weakening and enlargement of the heart muscle. Viral infections, such as Coxsackievirus B, adenoviruses, and influenza, can lead to DCM by causing inflammation and damage to heart tissue. Certain chemotherapeutic agents, including daunorubicin,...
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​Bullet to the Heart: A Case Report.

Gustavo Christian-Colón1, Gabriel Figueroa-Martínez2, Derick Rodriguez-Reyes2

  • 1Surgery, Ponce Health Sciences University, Ponce, PRI.

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Penetrating cardiac injuries (PCI) are highly fatal. This case shows a stable patient with a retained intracardiac bullet, managed conservatively due to absence of cardiopulmonary bypass, highlighting individualized treatment for such rare trauma.

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Area of Science:

  • Cardiovascular Surgery
  • Trauma Surgery
  • Emergency Medicine

Background:

  • Penetrating cardiac injuries (PCI) from gunshot wounds have extremely high mortality rates.
  • Retained intracardiac projectiles are rare but pose significant management challenges.
  • Cardiac tamponade can paradoxically limit hemorrhage, complicating treatment decisions.

Observation:

  • A 51-year-old male presented with gunshot wounds and an 8 mm bullet fragment in the right ventricle.
  • Despite a pericardial effusion and sternal fracture, the patient was hemodynamically stable.
  • Surgical exploration revealed a right ventricular epicardial wound without active bleeding.

Findings:

  • The intracardiac bullet was not removed due to the absence of cardiopulmonary bypass.
  • The patient received prophylactic heparin and was closely monitored.
  • Discharge occurred without complications, suggesting successful conservative management.

Implications:

  • This case demonstrates PCI without overt tamponade physiology, challenging typical presentations.
  • Conservative management of retained intracardiac projectiles may be viable in select stable patients.
  • Individualized approaches and further research are crucial for managing intracardiac foreign bodies in trauma.