Ruptured heart

Introduction Most of them are caused by sharp-edged sharps, bullets, shrapnel, etc., which penetrate the chest wall and the heart. A few of them are ruptured due to violent impact on the front 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.

Cause

Most of them are caused by sharp-edged sharps, bullets, shrapnel, etc., which penetrate the chest wall and the heart. A few of them are ruptured due to violent impact on the front pottery.

an examination

Related inspection

ECG dynamic electrocardiogram (Holter monitoring)

Cardiac hemorrhage overflows, the pericardial rupture remains open and the blood will flow from the front chest wound or flow into the pleural cavity. Clinically, signs of hypovolemia occur: such as pale, weak breathing, rapid pulse rate, decreased blood pressure, etc., patients can quickly fall into shock, due to massive bleeding.

Differential diagnosis

Pericardial tamponade: The pericardial cavity is the space 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 caused by blood accumulation in the pericardial cavity called blood pericardial or pericardial tamponade, which is the cause of rapid death of cardiac trauma. M-mode ultrasound showed the ventricle activity curve of the pericardium. When the pericardial tamponade, the direction of the anterior wall of the right ventricle changed, and the diastolic phase showed a centripetal movement, that is, the posterior displacement.

Heart penetrating injury: its pathological and clinical manifestations, on the one hand, 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.

Myocardial necrosis: should be medical myocardial infarction, refers to the sharp reduction or interruption of coronary artery blood supply, so that the corresponding part of the myocardium due to severe persistent ischemia, local necrosis occurs. Pain, the earliest and most prominent symptoms, the site of the anterior region, the back of the sternum, the left shoulder, and even the teeth, the upper abdomen, the lower xiphoid, etc., the degree is severe, lasts for hours or days, no incentives, rest and More nitroglycerin is not relieved. The patient has fear and a sense of death.

Pericardial injury: more common in penetrating cardiac trauma, penetrating cardiac trauma is caused by a strong, high-speed, sharp foreign body penetrating the chest wall or into the heart, a small number of rupture of the sternum or rib fracture Puncture the heart. Heart penetrating injuries have pericardial breaks, and sometimes there are many heart wounds, which are especially common in stab wounds and gunshot wounds.

Cardiac hemorrhage overflows, the pericardial rupture remains open and the blood will flow from the front chest wound or flow into the pleural cavity. Clinically, signs of hypovolemia occur: such as pale, weak breathing, rapid pulse rate, decreased blood pressure, etc., patients can quickly fall into shock, due to massive bleeding.

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