blunt closed cardiac injury
Introduction
Introduction to blunt closed heart injury A blunt closed heart injury accounts for about 10% to 25% of a chest injury, but it is often missed because of its lack of vigilance, insignificant performance, or masking of other injuries. Some people think that the incidence may be blunt chest. More than 50% of injuries. Clinically, cardiac closure injuries are often caused by a combination of several factors, most of which are caused by traffic accident injuries. basic knowledge The proportion of illness: 0.001% Susceptible people: no specific population Mode of infection: non-infectious Complications: rib fractures
Cause
Cause of blunt closed heart injury
The injury mechanisms are:
1 direct action: a certain strength of the one-way force directly affects the anterior region of the heart to cause damage, or may be associated with sternum and rib fractures.
2 Indirect effect: The abdomen suffers from sudden extrusion, a large amount of blood suddenly flows into the heart and large blood vessels, and the pressure in the cavity increases sharply, causing rupture damage.
3 Deceleration: The human body at high speed is suddenly decelerated. Due to inertia, the heart can collide with the front chest wall or the spine, or the heart can be twisted due to unequal deceleration, causing damage.
4 Squeeze: The heart is crushed between the hard sternum and the spine and injured.
5 knocking effect: shock wave directly acts on the damage caused by the heart.
Prevention
Cardiac blunt closure injury prevention
Prevent trauma and pay attention to safety. Patients with premature occlusion injury should be followed up regularly after discharge from the hospital. In the chest closed injury, severe myocardial contusion may occur in a few cases (1~2 months) in a few cases, or ventricular aneurysm may be formed in the myocardial contusion area or sudden rupture. Even leading to death, so regular follow-up after discharge, pay attention to post-processing.
Complication
Complications of blunt closed heart injury Complications, rib fractures, pneumothorax
Cardiac closure injuries often have combined injuries, such as sternal and rib fractures, rupture of internal organs in the chest and abdomen, blood pneumothorax, etc., heart failure occurs in severe cases, and pericardial occlusion is the most common symptom of closed heart injury. For shortness of breath, chest pain, early performance is not obvious, especially in the case of controversy, the general routine examination can not be implemented, so often misdiagnosis and missed diagnosis, when the symptoms appear often very dangerous and easily lead to death.
Symptom
Symptoms of blunt closed heart injury Common symptoms Chest pain Papillary muscle break Pericardial tamponade Heart penetrating injury Heart rupture
A blunt heart injury can cause varying degrees and types of damage, including:
1 pericardial injury, contusion or rupture, simple pericardial rupture is rare, usually combined with damage to other parts of the heart.
2 myocardial contusion, from small epicardial or subendocardial hemorrhage (myocardial shock), to full-thickness myocardial tear, hemorrhage, edema and necrosis.
3 heart rupture: most occur immediately after injury, causing major bleeding or pericardial tamponade; very few days after the injury, several days or weeks after the injury due to softening, myocardial contusion, softening, necrosis and delayed rupture, after the disease is relatively stable, suddenly severe Chest pain and pericardial tamponade.
4 Traumatic intracardiac septal defect: mostly ventricular septal rupture, the mechanism of occurrence is similar to ventricular rupture, interval tearing caused by sudden increase in heart pressure during sudden end-diastolic and early contraction of the heart chamber and closure of the valve. Delayed perforation caused by softening and necrosis after myocardial contusion.
5 valve injury: the most aortic valve, tear or perforation, followed by the mitral valve, often chordae or papillary muscle rupture, the original heart disease, such as aortic valve two-valve or Marfan syndrome , more susceptible to damage.
6 coronary artery injury: mostly left anterior descending branch laceration.
7 Traumatic ventricular aneurysm: a true ventricular aneurysm caused by necrosis or coronary artery occlusion after myocardial contusion.
Examine
Examination of blunt closed heart injury
(1) Pericardial puncture:
It is an important diagnostic and temporary treatment for patients with typical Beck triad, but there are more dangerous complications, and when the blood clots in the pericardial cavity are coagulated, false negatives may occur, so the clinical use of pericardial puncture should be cautious.
(2) Bedside echocardiography:
It can save inspection time, not only can accurately measure the blood in the pericardium, but also understand the structure of the heart and the combined injury of the chest and abdomen, which should be used as the preferred auxiliary examination.
(3) X-ray inspection:
Simple myocardial contusion has few positive signs, and the diagnostic value of electrocardiogram is large. It is characterized by ST-segment elevation and T-wave inversion, mostly tachycardia, pre-systolic and paroxysmal atrial fibrillation, and more critically ill patients. Film, but it is not easy to identify the degree of mediastinal and heart shadow increase, and increase the inspection time, should be exempted from X-ray examination.
(4) Serum phosphocreatine kinase
The isozyme CPK-MB and lactate dehydrogenase isozymes LDH1 and LDH2 have diagnostic value.
Diagnosis
Diagnosis and diagnosis of blunt closed heart injury
diagnosis
Diagnosis can be based on medical history, clinical symptoms, and laboratory tests.
Differential diagnosis
First, the heart penetrating injury
Symptom
Acute pericardial tamponade is in a state of shock, the skin is wet and cold, breathing is fast, irritability, gaze, and uncooperative examination.
2. Signs
Blood pressure drops, pulse speed, heart sounds weak and jugular vein engorgement and other pericardial tamponade signs, if accompanied by ventricular septal perforation, the anterior region can hear murmurs.
3. Auxiliary inspection
1X line examination, the heart shadow is widened, and sometimes the liquid level is visible in the pericardial cavity, and the heart beat is weakened under fluoroscopy.
2 Central venous pressure measurement helps identify bleeding and pericardial tamponade.
Second, large blood vessel damage
Clinical manifestation
There are several types of aortic injuries:
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.
2. X-ray inspection
The upper mediastinal shadow can be broadened, and aortic angiography can identify the location and extent of aortic injury.
