Heart injury – damage to the heart caused by the action of a physical factor.
Peacetime injuries are quite common and make up 7-14% of the total number of chest injuries.
- open heart injury;
- closed heart trauma.
It is a penetrating damage with a violation of the integrity of the chest and pericardium.
Etiology and pathogenesis
An open trauma is mainly the result of striking a piercing-cutting weapon, but can also be observed in road and work injuries. The anatomical version depends on the type of weapon and the force of the strike. There is possible damage only to the pericardium, superficial lesions of the myocardium and coronary vessels, through wounds of the heart and penetrating wounds in its cavity. The last two types can be combined with damage to the valves and the septum of the heart, as well as the aortic root, with the formation of traumatic defects. The right and left ventricles are damaged equally often – 33-44% of cases, the left atrium in 2-7%, the right ventricle in 4- 16% of observations.
It is damage to the heart that is not accompanied by a violation of the integrity of the chest and pericardium.
Etiology and pathogenesis
Closed heart injury occurs in the following variants: contusion, concussion, wall rupture and intracardiac structures.
This injury may occur due to:
- push and punch in the chest;
- hydraulic action of blood in the cavities;
- compressional impulse from the lungs or diaphragm at break;
- injuries as a result of bruising on the chest, which is typical of traffic accidents.
When a heart is shaken, no macroscopic or microscopic changes in the myocardium are detected. During slaughter, there may be pericardial and myocardial tears with the development of intrapericardial or subepicardial hemorrhages. There may be the most dangerous breaks in the wall of the heart and intracardiac structures.
The main cause of the adverse outcome of injuries is a violation of hemodynamics, which leads to a syndrome of low cardiac output — significant blood loss, shock, and cardiac tamponade. In addition, as a result of damage to the intracardiac structures, traumatic heart defects suddenly appear – valve insufficiency and defects of the heart walls. The heart usually cannot quickly adapt to the increased hemodynamic load and expands (dilates). Circulatory failure develops rapidly and progresses steadily. The liver, ascites, hydrothorax, peripheral edema increase. Circulatory disorders are resistant to drug therapy and more than 50% of these patients die in the first 15 days after the injury. In severe lesions of the chest and lungs, the patient’s condition worsens due to respiratory disorders from ventilation problems and the development of “shock lung” syndrome. As a result, circulatory and respiratory disorders lead to severe hypoxia and various disorders of homeostasis.
Diagnosis and clinic
The diagnosis of injury to the heart is made on the basis of studying the mechanism of trauma, clinical assessment of the victim, the degree of shock, identifying symptoms of cardiac tamponade. In addition to general clinical methods, the definition of central venous pressure, electrocardiography and pericardial puncture should be used. With a sudden accumulation of 200 ml of blood in the pericardium, a pronounced picture of the compression of the heart arises, and with an accumulation of 500 ml, blood circulation stops. The diagnosis with a closed injury can be established only on the basis of a set of symptoms. The main symptoms are pain in the region of the heart, shortness of breath, impaired hemodynamics and arrhythmia. With electrocardiography, myocardial ischemia, ventricular and supraventricular rhythm disturbances with a change in conductivity are shown. Additional diagnostic information about heart trauma is determined by the level of cardiac enzymes (LDH – lactate dehydrogenase) on the basis of auscultation and phonocardiography. To clarify the anatomy and severity of the lack of need it is necessary to conduct sensing and radiopaque examination of the heart and great vessels.
With a closed injury of the heart during the first 4 days, careful monitoring of the patient’s condition, constant ECG monitoring and treatment, as in myocardial infarction should be carried out. In a traumatic defect, one of the digitalis preparations, diuretics, potassium and other drugs normalize the rhythm. It is important to limit the introduction of fluid with the maintenance of zero water balance. These measures are aimed at the prevention and treatment of arrhythmias, dilatation and decompensation of blood circulation. In the open trauma, a feature of modern surgical tactics is the simultaneous anti-shock therapy, surgery and resuscitation. The operation is performed urgently and consists in suturing the external wound of the heart. In the presence of traumatic pericarditis, subtotal pericardiectomy is performed. In penetrating wounds with the formation of defects, after suturing the external wound, patients within 1-2 weeks should be transferred to specialized cardio-surgical hospitals to clarify the diagnosis and, if necessary, to correct the defect in conditions of artificial circulation.