In the United States, trauma is the leading cause of death among those who are 1-44 years old, with cardiovascular injuries representing the second most common cause of traumatic death after central nervous system injuries. Evaluation of trauma patients with suspected cardiac injury may be complex and include electrocardiography, measurement of cardiac biomarkers, and imaging examinations. Contrast material-enhanced computed tomography (CT) has become one of the most valuable imaging tools available for evaluating hemodynamically stable patients with suspected cardiac injury. The presence of hemopericardium, with or without cardiac tamponade, is one of the most significant findings of cardiac injury. Other complications that result from blunt cardiac injury, such as pericardial rupture and cardiac herniation, may be readily depicted at multidetector CT. Assessment of patients with cardiac injuries, particularly those with penetrating injuries, is a challenging and time-critical matter, with clinical and imaging findings having complementary roles in the formation of an accurate diagnosis. Patients who are hemodynamically stable, particularly those with penetrating cardiac injuries, also may benefit from a timely imaging examination. In addition to chest radiography, other available modalities such as transthoracic and transesophageal echocardiography, nuclear medicine, and magnetic resonance imaging may play a role in selected cases.

https://pubs.rsna.org/doi/pdf/10.1148/rg.323115123

Imaging Patients with Cardiac Trauma

The Focused Assessment with Sonography for Trauma examination is an invaluable tool in the initial assessment of any injured patient. Although highly sensitive and accurate for identifying hemoperitoneum, occasional false negative results do occur in select scenarios. We present a previously unreported case of survival following blunt cardiac rupture with associated negative pericardial window due to a concurrent pericardial wall laceration.

/pdf/false-negative-pericardial-focused-assessment-with-36khebindc.pdf

False negative pericardial Focused Assessment with Sonography for Trauma examination following cardiac rupture from blunt thoracic trauma: a case report

Objective This review aims to summarize the literature regarding blunt cardiac trauma (BCT), focusing on the mechanism of injury, presentations, diagnostic, and treatment approaches to provide an up-to-date perspective and to identify the areas requiring further investigation. Background BCT is a relatively rare, but likely underdiagnosed, consequence of blunt chest trauma. BCT occurs in less than 10% of all trauma admissions although it is responsible for approximately 25% of traumatic deaths. BCT often occurs due to forceful impact, rapid deceleration, or crush injuries and the most common causes include motor vehicle accidents, pedestrians struck by motor vehicles, and falls from a significant height. While BCT is certainly an important condition with significant clinical implications, the current literature is limited comprised of mainly case reports. BCTs are often complex cases with various presentations, comorbid injuries, diagnostic modalities, and treatments. Methods PubMed was searched for retrospective, prospective, randomized control trials, case report studies, and previous related reviews investigating BCT published from January 1, 1985 to February 1, 2021. Exclusion criteria included if the full length manuscript was not available and if insufficient data was provided regarding the patient outcomes or the case presented in case reports. Conclusions A wide variety of injuries, mechanisms, presentations, and treatments are possible with BCT. Commonalities in initial investigations include a thorough history and physical exam where appropriate, lab work to evaluate patient status, and imaging to diagnose structural injuries. Treatment often begins with stabilization of the patient and rapid initiation of interventions aimed at underlying structural or rhythm abnormalities. As the current literature is limited, further study into BCT is necessary. As BCT is relatively rare and occurs sporadically at individual centers, widespread data collection from BCT patients regarding their treatment and outcomes is essential in order to collect the required data for retrospective or prospective studies. The widespread establishment of multicenter or national databases may be a solution to address the limited data in this field allowing identification of optimal treatments for BCT patients, addressing the limitations in the field of BCT, and allow the continued improvement in the outcomes of patients who experience BCT.

/pdf/blunt-cardiac-trauma-a-narrative-review-4l8e7vybuu.pdf

Blunt cardiac trauma: a narrative review

In German-speaking countries, most serious thoracic injuries are attributable to the impact of blunt force; they are the second most frequent result of injury after head injury in polytrauma patients with multiple injuries. Almost one in every three polytraumatized patients with significant chest injury develops acute lung failure, and one in every four, acute circulatory failure. The acute circulatory arrest following serious chest injury involves a high mortality rate, and in most cases it reflects a tension pneumothorax, cardiac tamponade, or hemorrhagic shock resulting from injury to the heart or one of the large vessels close to it. Brisk drainage of tension pneumothorax and adequate volume restoration are therefore particularly important in resuscitation of multiply traumatized patients, as are rapid resuscitative thoracotomy to allow direct heart massage, drainage of pericardial tamponade, and control of hemorrhage. However the probability of survival described in the literature is very low for patients sustaining severe chest trauma with acute cardiac arrest. The case report presented here describes a female polytrauma patient who suffered an acute cardiac arrest following cardiac tamponade after admission in the emergency department and who survived without neurological deficits after an emergency thoracotomy. Selections from the topical literature can help the treating physician in the emergency department in making decisions on whether an emergency thoracotomy is indicated after a blunt chest injury and on the procedure itself. Language: de

Cardiac arrest following blunt chest injury. Emergency thoracotomy without ifs or buts

Cardiac rupture is the most extreme manifestation of blunt cardiac injury. In the first half of the 20th century this lesion was uniformly fatal. Since the first successful post-traumatic cardiorrhaphy by Desforges in 1955, multiple case reports and retrospective reviews have documented successful operative repair and survival of patients with this injury. Despite these successes, blunt cardiac rupture remains associated with a high mortality rate. The rarity of this condition and the heterogeneity of the literature make determination of exact epidemiologic data difficult. The classic clinical presentation is not universal and a subset of patients may present asymptomatically. Rapid transportation to medical care, accurate timely diagnosis and emergent operative intervention are essential for successful outcome. The use of ultrasonography in the trauma bay is a key component of early identification of these injuries. Specific outcome factors associated with survival are difficult to determine and even in ...

Cardiac rupture following blunt trauma

Blunt cardiac rupture: isolated and asymptomatic.

147. A Prospective, Multi-Center, Randomized, Controlled, Blinded Trial of Vagus Verve Stimulation for Difficult to Treat Depression: The Recover Trial Baseline Data

http://www.epilepsybehavior.com/article/S1525505023002524/pdf

ASCEND: A randomized controlled trial of titration strategies for vagus nerve stimulation in drug-resistant epilepsy

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Blunt cardiac rupture: isolated and asymptomatic.

147. A Prospective, Multi-Center, Randomized, Controlled, Blinded Trial of Vagus Verve Stimulation for Difficult to Treat Depression: The Recover Trial Baseline Data

ASCEND: A randomized controlled trial of titration strategies for vagus nerve stimulation in drug-resistant epilepsy