Identifying the broken heart: predictors of mortality and morbidity in suspected blunt cardiac injury

Joseph, Bellal; Jokar, Tahereh Orouji; Khalil, Mazhar; Haider, Ansab; Kulvatunyou, Narong; Zangbar, Bardiya; Tang, Andrew; Zeeshan, Muhammad; OʼKeeffe, Terence; Abbas, Daniyal; Latifi, Rifat; Rhee, Peter

doi:10.1016/j.amjsurg.2015.10.027

Cited by 27 publications

(17 citation statements)

References 13 publications

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“…Complications of thoracic trauma are a risk factor, and sternal fracture is sometimes associated with blunt cardiac injury. However, sternal fracture is not specific for blunt cardiac injury [2] , [3] , and rib fracture does not always cause blunt cardiac injury [3] , [4] . Serum cardiac enzymes (e.g., troponin, creatine kinase-MB fraction) are associated with mortality and the severity of blunt cardiac injury and blunt trauma [5] , [6] .…”

Section: Discussionmentioning

confidence: 97%

Identification of a small pericardial effusion on contrast-enhanced computed tomography indicating cardiac perforation and pericardial injury following blunt trauma: A case report

Esumi

Kaneko

Akama

et al. 2021

Trauma Case Reports

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Blunt trauma may cause cardiac perforation requiring emergency surgical repair. Cardiac perforations are usually diagnosed by the presence of a pericardial effusion on echocardiography. However, cardiac perforations and pericardial effusions are sometimes too small to detect, resulting in underdiagnosis. In this case report, we describe a 22-year-old man who was involved in a traffic accident, admitted in a state of shock, and was initially treated for tension pneumothorax and liver and spleen injuries. His initial computed tomography scans revealed a small region of enhancement, corresponding to a small pericardial effusion, indicative of a cardiac perforation. Thus, an emergency median sternotomy was performed. He was diagnosed with perforation of the left atrial ear and right atrium, which were repaired surgically. His liver and spleen injuries were also treated, and the patient was discharged 44 days after admission. The detection of a small pericardial effusion on enhanced computed tomography enabled rapid diagnosis of a cardiac perforation and ensured emergency surgical repair could be performed as soon as possible. Learning objectives To acknowledge the difficulty of diagnosing cardiac perforation in patients with pericardial injury, based on conventional signs of blunt cardiac injury, such as sternal fracture, serum cardiac enzymes, and hemothorax. To recognize that a small pericardial effusion on enhanced computed tomography scans is an important finding that should raise suspicion of cardiac perforation and pericardial injury.

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Section: Discussionmentioning

confidence: 97%

Identification of a small pericardial effusion on contrast-enhanced computed tomography indicating cardiac perforation and pericardial injury following blunt trauma: A case report

Esumi

Kaneko

Akama

et al. 2021

Trauma Case Reports

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“…It found that when comparing survivors and non-survivors, the non-survivors were more likely to have an elevated cTnI and higher mean level of troponin. That same study stated that a troponin level of greater than 0.2 was significantly more common in the non-survivor group and was found to be a predictor of mortality [55]. Velmahos et al [56] studied 333 patients with thoracic trauma and noted the negative predictive value of cardiac troponins was 21% and the positive predictive value was 94%.…”

Section: Cardiac Contusionmentioning

confidence: 99%

“…Troponin elevations can occur in response to blunt trauma by causing direct myocardial injury. There are no definitive diagnostic criteria available which makes diagnosis of BCI difficult [54,55]. The diagnosis is typically made if abnormal electrocardiogram, abnormal echocardiogram, and/or elevated troponin levels are present in a patient who presents with blunt thoracic trauma.…”

mentioning

confidence: 99%

A Review of Cardiac and Non-Cardiac Causes of Troponin Elevation and Clinical Relevance Part I: Cardiac Causes

2017

JCCR

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IntroductionCardiac troponin T (cTnT) and troponin I (cTnI) are cardiac regulatory proteins that control the calcium mediated interaction between actin and myosin [1]. The troponin complex consists of three subunits: troponin C, troponin I, and troponin T. This complex is located on the myofibrillar thin (actin) filament of striated (skeletal and cardiac) muscle. The cardiac isoforms troponin T and I are only expressed in cardiac muscle [1].In the year 2007 a consensus statement from the Joint European Society of Cardiology and The American College of Cardiology committees redefined myocardial infarction (MI) as an elevation of cTnT or cTnI in conjunction with clinical evidence of myocardial ischemia [2]. They recommended highsensitivity cardiac troponin assays to rule out MI using a 3-hour pathway based on the 99 th percentile of the normal reference range [2]. Cardiac troponins are detected in the serum by the use of monoclonal antibodies to epitopes of cTnI and cTnT. These antibodies are highly specific for cardiac troponin but do not react with skeletal muscle troponins [3,4]. Troponin assays are quite sensitive and can detect <1 g of myocardial necrosis; therefore, the diagnosis of myocardial infarction requires that cTn must be above the 99 th percentile upper reference limit for the specific assay being used [5]. Some studies have reported that the 99 th percentile reference limit differs between men and women when measured with high-sensitivity assays for cardiac troponin [6].An elevation of cTn indicates the presence of, but not the underlying reason for, myocardial injury. Elevated troponins have been noted in several clinical conditions in addition to acute myocardial infarction (AMI). These conditions include pulmonary embolism, sepsis, heart failure, myocarditis, myocardial contusion, critical illness, cardio-toxic chemo, defibrillator shocks, atrial fibrillation, and end stage renal disease. Elevated cTnT and cTnI almost always imply a poor prognosis regardless of the mechanism by which troponins were released from cardiac myocytes into circulation. Ottani et al. found that the odds ratio for death and MI was 3.44-fold at 30 days in the cTnT-positive group compared to patients with unstable angina who did not have elevated troponins [7].The aim of this article is to highlight different conditions in which elevated troponins have been commonly noted, and to discuss the suggested mechanisms for elevated troponins in these patients. It is still unclear how to manage troponin elevation in clinical conditions other than AMI, but it is important to note the differential diagnosis for elevated troponins and the clinical significance of troponin elevation in each setting. Troponin elevation reflects acute or chronic myocardial damage but is not exclusive for ACS, thus causing some problems with interpretation of results. Differentiating elevated troponins due to non-coronary diseases is challenging; however, this differentiation is paramount in order to provide timely and appropriate treatment. This is a t...

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“…There is a controversy regarding the prognostic value of TnI. [4][5] Briefl y, there is no conclusion on the changes and clinical values of TnI; therefore, we aim to explore the changes and clinical signifi cance of serum TnI in trauma patients.…”

Section: Introductionmentioning

confidence: 99%

Changes and significance of serum troponin in trauma patients: A retrospective study in a level I trauma center

Dou¹

2022

World Journal of Emergency Medicine

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Identifying the broken heart: predictors of mortality and morbidity in suspected blunt cardiac injury

Cited by 27 publications

References 13 publications

Identification of a small pericardial effusion on contrast-enhanced computed tomography indicating cardiac perforation and pericardial injury following blunt trauma: A case report

Identification of a small pericardial effusion on contrast-enhanced computed tomography indicating cardiac perforation and pericardial injury following blunt trauma: A case report

A Review of Cardiac and Non-Cardiac Causes of Troponin Elevation and Clinical Relevance Part I: Cardiac Causes

Changes and significance of serum troponin in trauma patients: A retrospective study in a level I trauma center

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