penetrating heart injury
Introduction
Introduction to heart penetrating injury Heart penetrating injuries account for about 2.8% to 12% of the total number of hospitalized chest injuries. All parts of the heart can be injured, but the injury rate is related to the exposure of the heart chamber to the anterior chest wall. The hospital mortality rate for heart penetrating injuries has previously been 60% for gunshot wounds and 15% for stab wounds. The severity depends on two aspects: on the one hand depending on the injury mechanism, ie the nature, size and speed of the penetrating substance; on the other hand, it depends mainly on the location of the injury, the size of the wound and the condition of the pericardial rupture. basic knowledge The proportion of illness: 0.001% Susceptible people: no specific population Mode of infection: non-infectious Complications: shock
Cause
Cause of heart penetrating injury
It can be a bullet wound, a shrapnel or a sharp knife stab wound, etc. In addition, there are iatrogenic injuries caused by interventional diagnosis and treatment techniques.
Prevention
Heart penetration injury prevention
The disease is accidental and there are no effective precautions. Mainly to strengthen protective measures in daily life and work, pay attention to safety and avoid external damage.
Complication
Complications of cardiac penetrating injury Complications
If the first aid is not timely, it is easy to cause death.
Symptom
Symptoms of penetrating heart injury Common symptoms Blood pressure drop Respiratory sensation Pericardial breakage Pulse fine speed sputum Hypotension Systolic pressure Drop Pericardial bleeding Pericardial tamponade Heart function Sudden decompensation
The pathological and clinical manifestations of cardiac penetrating injury depend on the injury mechanism, ie the nature, size and speed of the penetrating substance. For example, more than 80% of the cases caused by firearm injuries are killed on site, while about half of the stab wounds are still reachable. On the other hand, depending on the location of the injury, the size of the wound, and the condition of the pericardial rupture, when the pericardial rupture is large enough, the clinical manifestation is mainly hemorrhagic shock, or even rapid death, small pericardial rupture, or surrounding tissue ( Such as pericardial fat, lungs, etc. or blockage of blood clots, cardiac bleeding can cause acute pericardial tamponade, restricting diastolic heart, obstructed blood flow to the vena cava and reduced cardiac output.
The pericardial rupture caused by gunshot wounds is large, mainly manifested as hemorrhagic shock, and the pericardial rupture of knife stab wounds is easily blocked, 80% to 90% of occipital tamponade occurs, and pericardial tamponade is beneficial to reduce bleeding of the heart. There is more bleeding but no tamponade. However, if it is not released in time, it will quickly lead to circulatory failure. When the heart is very cold, it can close itself and stop bleeding.
Examine
Heart penetrating examination
1X line: Heart shadow can be generally increased due to pericardial effusion or pericardial effusion. Chest X-ray can show whether there is a hemothorax, pneumothorax, metal foreign body or other organs combined with injury. Echocardiography is helpful for the diagnosis of pericardial tamponade and cardiac foreign body, and can estimate the amount of pericardial blood.
2 electrocardiogram: can show ST-T changes similar to pericarditis, and can occur premature beats, atrial fibrillation and conduction block.
3 laboratory tests, serum GOT and LDH can be elevated, ESR increased.
Diagnosis
Diagnosis of heart penetrating injury
First, the heart is closed
1. Symptoms: Myocardial contusion in the anterior or post-sternal pain with palpitations, shortness of breath and other symptoms.
2. Signs: The pericardial area can hear the pericardial friction sound, the pulse is faster and weaker, sometimes irregular, and there may be hepatomegaly and lower extremity swelling in patients with heart failure. If the ventricular septum and valvular injury are combined, the pathology can be heard. Sexual noise.
Second, large blood vessel damage
Clinical manifestations of aortic injury have the following categories:
1 The aorta is partially or completely transected, and the wounded often die of massive hemorrhage within a few minutes.
2 After aortic hemorrhage, due to the obstruction of the aortic adventitia and mediastinal pleura, localized hematoma, the wounded can survive for a short time, but often died within a few days due to another major bleeding.
3 The aorta intima and middle layer are damaged and the adventitia is intact, forming a pseudoaneurysm. The wounded may have no obvious symptoms and are often found in X-ray examination.
