Cardiac Changes in Hospitalized Patients of Trauma

Abstract

Modern clinical management of the patients sustaining traumatic injuries and thermal burns has resulted in their longer survival, but the clinical and pathological effects of these traumatic injuries over the myocardium have been largely neglected. It is speculated that certain factors such as the inflammatory and degenerative lesions of the heart, prolonged clinical course, and the subsequent stress and strain may play role in hastening the death. In the present study, 125 hospitalized cases of traumatic injuries and thermal burns brought for medicolegal autopsy were examined, with the purpose to find out the incidence, its significance, and the extent of the myocardial lesions due to stress and strain following trauma. About 20% patients had myocardial lesions recognized at gross and histological examination at autopsy. A myocardial lesion does develop in the cases of traumatic injuries and thermal burns. No significant sex difference is seen in the cases showing positive myocardial lesions. However, a relationship exists between these myocardial lesions and the after-effects developing in the cases of trauma. These myocardial lesions seen in the cases of traumatic injuries can be termed as early ischemic or anoxic lesions in the absence of any specific coronary pathology. The intensity of myocardial lesions increases with increase in the survival period of the patient. The findings in the study support the concept of human stress cardiomyopathy and demonstrate the potential significance of stress in precipitating death.

Modeling Cardiac Dysfunction Following Traumatic Hemorrhage Injury: Impact on Myocardial Integrity

“…However in our model, volume resuscitation to baseline LVEDV was not able to restore cardiac function to pre-shock levels. This resultant cardiac dysfunction is increasingly recognized as a key determinant of critical care utilization and survival in trauma patients (10, 23, 24).…”

“…We have previously shown that trauma patients have elevated levels of biomarkers of myocardial damage within the first 2 h of injury, and this is associated with increased risks of adverse cardiac events and mortality (8, 9). Cardiac histopathology in non-survivors has shown multiple pathological identifiers of indirect or secondary cardiac injury (10, 11). The pathophysiology and mechanisms of secondary cardiac dysfunction are unknown, with most critical care studies limited to sepsis (12).…”

Early structural changes of the heart after experimental polytrauma and hemorrhagic shock

“…However, the concept of an early development of trauma-driven cardiomyopathy, resulting from the posttraumatic systemic inflammatory response remains to be proven and examined in detail. In a recent clinical study, post-injury cardiomyopathy occurred in 20% of the fatal cases after severe trauma and histopathological examination of heart specimens revealed significant myocardial lesions even in the absence of coronary alterations [ 7 ]. Most likely, these changes resulted from the patient’s reaction to ischemia and shock conditions without a direct injurious impact on the heart [ 7 ].…”

Mechanisms Involved in Secondary Cardiac Dysfunction in Animal Models of Trauma and Hemorrhagic Shock

“…Lesions were apparent as early as four hours after injury, and typically located around the left ventricle. Histological changes included subendocardial haemorrhages, interstitial oedema, mononuclear infiltration, coagulative necrosis and evidence of hypoxic injury in the absence of existing coronary disease (19). An older post-mortem study of homicide trauma victims has supported these findings, and revealed myofibrillar degeneration, namely scattered clusters of myocytes with homogeneous eosinophilic transverse bands alternating with areas of fine granulation (20).…”