Penetrating cardiac injury

Introduction 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.

Cause

It can be a bullet wound, a shrapnel injury, or a knife, a scissors, etc., and there are iatrogenic injuries caused by interventional diagnosis and treatment techniques.

an examination

Related inspection

Dynamic electrocardiogram (Holter monitoring) Doppler echocardiography

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 those caused by firearm injuries die on the spot, and about half of the stab wounds can still reach the hospital; 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. When the pericardial rupture is large enough, it is mainly characterized by hemorrhagic shock and even death. The pericardial rupture is small, or blocked by surrounding tissues (such as pericardial fat, lungs, etc.) or blood clots. Cardiac hemorrhage can cause acute pericardial tamponade, restricting diastolic relaxation, obstructing blood flow to the vena cava and reducing cardiac output. The pericardial rupture caused by gunshot wounds is large, mainly manifested as hemorrhagic shock, while the pericardial rupture of knife stab wounds is easily blocked, and 80% to 90% of pericardial tamponade occurs. Pericardial tamponade is beneficial to reduce bleeding in the heart. The survival chance of the patient is more bleeding than that without tamponade. However, if it is not released in time, it will lead to circulatory failure. When the heart is very cold, it can close itself and stop bleeding.

Differential diagnosis

Heart rupture: caused by sharp-edged sharps, bullets, shrapnel, etc., which penetrate the chest wall and the heart, and a few of them cause rupture of the heart due to violent impact on the anterior pottery. When the myocardial infarction has not been relieved for more than 6 to 7 hours, the heart muscle is softened due to infiltration of the central granulocytes, and the heart rupture may occur under the impact of blood flow, which is one of the important complications of myocardial infarction. The right ventricular rupture is the most common, followed by the left ventricle and the right atrium, and the rupture of large vessels in the left atrium and pericardium is rare.

Cardiac tamponade: The main signs are: 1, jugular vein engorgement, abnormally elevated venous pressure. 2, blood pressure drops, pulse pressure is reduced, severe cases can cause shock. 3, odd pulse. 4, heart sounds weak, far away. 5, difficulty breathing, sitting and breathing, leaning forward, accompanied by hairpins.

Pericardial filling: The heart is the power organ that maintains the blood circulation of the human body. It guarantees the blood supply to all organs and tissues throughout the body. The pericardium is a cystic structure that wraps the heart and the roots of the heart and blood vessels. The pericardial cavity refers to the gap between the parietal pericardium and the visceral pericardium on the surface of the heart. A small amount of light yellow liquid in the normal pericardial cavity lubricates the surface of the heart. Traumatic heart rupture or pericardial vascular injury causes blood accumulation in the pericardial cavity, called blood pericardial or pericardial tamponade, which is the cause of rapid death of cardiac trauma.

Cardiac closure injury: 1. Symptoms of myocardial contusion after injury in the anterior region or post-sternal pain with palpitations, shortness of breath and other symptoms. 2. The signs of pericardial rubbing can be heard in the anterior region of the heart. The pulse is fast and weak, sometimes irregular. Hepatic enlargement and lower extremity swelling may occur in patients with heart failure. Pathological murmurs can be heard in the anterior region of the ventricle and in the anterior region of the valve. 3. Auxiliary inspection of the 1X line. Heart shadow can generally increase due to pericardial effusion or pericardial effusion. 2 ECG. It can present ST-T changes similar to pericarditis, and can occur in premature beats, atrial fibrillation, and conduction block. 3 laboratory tests. Serum GOT and LDH can be increased, and ESR is increased.

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 those caused by firearm injuries die on the spot, and about half of the stab wounds can still reach the hospital; 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. When the pericardial rupture is large enough, it is mainly characterized by hemorrhagic shock and even death. The pericardial rupture is small, or blocked by surrounding tissues (such as pericardial fat, lungs, etc.) or blood clots. Cardiac hemorrhage can cause acute pericardial tamponade, restricting diastolic relaxation, obstructing blood flow to the vena cava and reducing cardiac output. The pericardial rupture caused by gunshot wounds is large, mainly manifested as hemorrhagic shock, while the pericardial rupture of knife stab wounds is easily blocked, and 80% to 90% of pericardial tamponade occurs. Pericardial tamponade is beneficial to reduce bleeding in the heart. The survival chance of the patient is more bleeding than that without tamponade. However, if it is not released in time, it will lead to circulatory failure. When the heart is very cold, it can close itself and stop bleeding.

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