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Traumatic myocardial dysfunction
Insights
Traumatic myocardial dysfunction is common after blunt chest trauma, often missed by standard tests. Radionuclide angiography reveals this cardiac injury is dynamic and more frequent than previously thought.
Area of Science:
- Cardiology
- Trauma Medicine
- Diagnostic Imaging
Background:
- Traumatic myocardial dysfunction is an underdiagnosed cause of trauma-related mortality.
- Electrocardiography and serum enzymes are unreliable for detecting cardiac injury post-blunt chest trauma.
Purpose of the Study:
- To evaluate the diagnostic accuracy of first-pass biventricular radionuclide angiography in assessing traumatic myocardial dysfunction.
- To compare radionuclide angiography findings with electrocardiograms and creatine kinase isoenzyme levels in trauma patients.
Main Methods:
- Seventy-four patients with blunt chest and multisystem trauma were assessed.
- Electrocardiograms and creatine kinase-MB levels were monitored for 3 days.
- First-pass radionuclide angiography was performed 24-48 hours post-admission to assess ventricular function and wall motion.
Main Results:
- Radionuclide angiography detected abnormalities in 74% of patients, significantly higher than electrocardiogram (28%) or creatine kinase (8%) abnormalities.
- Electrocardiographic findings correlated with angiographic abnormalities in 76% of cases.
- Follow-up angiography showed resolution of abnormalities in 75% of patients within 3 weeks, indicating a dynamic process.
Conclusions:
- Electrocardiograms and creatine kinase isoenzyme are insensitive, static indicators of traumatic myocardial dysfunction.
- First-pass radionuclide angiography is a practical and valuable tool for detecting and managing traumatic myocardial dysfunction, revealing its common and dynamic nature.
Abstract:
Traumatic myocardial dysfunction is a frequently unsuspected, undiagnosed contributor to deaths from trauma. Electrocardiography, serum enzymes, and radionuclide myocardial scans are insensitive indicators of cardiac injury following blunt chest trauma. First-pass biventricular radionuclide angiography can accurately determine right and left ventricular ejection fractions and assess left ventricular segmental wall motion. Since August, 1980, we have evaluated 74 consecutive patients with blunt chest and multisystem trauma. Electrocardiograms and measurements of the myocardial band isoenzyme of creatine kinase were obtained at admission and repeated at 24 hour intervals for 3 days. Radionuclide angiography was performed 24 to 48 hours after admission. The electrocardiogram was abnormal in 21 patients (28%), levels of creatine kinase isoenzyme were elevated in six, and radionuclide angiographic abnormalities were present in 55 patients (74%). Electrocardiographic abnormalities correlated anatomically with angiographic abnormalities in 16 patients (76%). On follow-up radionuclide angiography, abnormalities had disappeared in nine of 12 patients restudied at 3 weeks. This study documents that the electrocardiogram and creatine kinase isoenzyme elevations are static, insensitive indicators of traumatic myocardial dysfunction. Radionuclide angiography with studies of left ventricular segmental wall motion demonstrate that traumatic myocardial dysfunction, although sometimes transitory, is a dynamic phenomenon that is more common than previously suspected. First-pass radionuclide angiography and wall motion studies are practical and valuable adjuncts to the management of the injured patient.