Stupid injury of heart
Contents:
Description:
The stupid injury of heart (heart bruise) most often arises during the work with mechanisms and at the road accidents.
Injuries of heart find in 10–76% of cases of death at injuries, injuries of heart often happen the true, but not recognizable, proximate cause of death. Stupid injuries make 1/3 all heart injuries. The frequency relation at men and to women — 2,7:1. Injuries of heart happen in 70,9% of car accidents, 9,5% of injuries of pedestrians, 7,8% of motorcycle accidents, 7,6% of falling from height. In 16,3% of cases patients with stupid injuries of heart have no other damages. 47,5% of patients in addition to an injury of CCC have damages of two more systems — most often it are ChMT, injuries of extremities and stupid injuries of a stomach, is more rare — injuries of bodies of a small pelvis, soft tissues and a backbone. 60,6% of patients have no injuries of a bone skeleton of a thorax. Extremely seldom stupid injury of heart is combined with an aorta injury. 0,3% of patients with a stupid injury have an anguish or a rupture of a myocardium or a pericardium, and the frequency of ruptures of walls of all cameras of heart is approximately identical.
Symptoms of the Stupid injury of heart:
The main complaints at a heart bruise — thorax pain, an asthma and interruptions in cardiac performance. Quite often numerous complaints are caused by the accompanying injuries of other bodies. Find out circumstances and the mechanism of an injury, if necessary report about a case in law enforcement agencies. In 80–90% of cases of a rupture of walls of heart patients die on the spot incidents. According to the research MIEMMS, 50% of the patients brought to clinic by helicopter within 30 min. after an injury were in a condition of clinical death; 87,5% from them had objective signs of a cardiac tamponade.
Objective inspection.
The specific symptomatology is absent. Register outside damages and symptoms of the other accompanying injuries, in 30% of cases find the hematoma on the front surface of a thorax repeating contours of a steering wheel — a symptom of the tattooed wheel.
Tool diagnosis. The gap is usually diagnosed intraoperatsionno. At a stable condition of a hemodynamics in case of an incomplete rupture of a wall or a bruise of heart carry out the following diagnostic tests. Radionuclide ventrikulografiya. In 48% of cases reveal anomalies of the movement of the injured heart wall (in 92% from them — anomaly of a right ventricle); in 40% — disturbance of global contractility of a right ventricle (fraction of emission less than 44%). The diagnostic value of a method is especially high during 24–48 h from the moment of an injury. An ECG and definition of KFK MB fraction — low-sensitive and not specific tests. Nevertheless, to all patients carry out an ECG in 12 standard and right chest leads, at 20% of patients reveal disturbances of a rhythm. ЭхоКГ: In 40% of cases at transthoracic and in 63% of cases at a transesophageal research find disturbances of local and global contractility of a right ventricle at heart bruises. Recommend to all patients carrying out transesophageal EhoKG for diagnosis of damage of the structures of heart which are badly visualized transtorakalno and retrocardial bodies. At cardiorrheses reveal localization and size of a gap, diagnose a hemopericardium. In 25% of cases of a cardiorrhesis of EhoKG-issledovaniye yields false-negative results. The X-ray analysis of bodies of a thorax matters only for diagnosis of injuries of a skeleton of a thorax; sometimes find signs of penetration of the broken fragments of edges or a breast in a mediastinum. KT recommend to all patients with signs of injury of a skeleton of a thorax, multiple injuries and objective signs gidro-or pheumothorax. Reveal dislocation of heart through ruptures of a pericardium, a hemothorax, a hemopericardium, fractures of edges, a breast and backbone. Estimate the accompanying damages of other bodies, including a spinal cord.
Reasons of the Stupid injury of heart:
The damage rate of heart depends at most, durations of blow and change of its force on time. At classical option of an injury — a short-term compression of heart between a breast and a backbone at blow about a wheel of the car or falling during the sports — injuries of heart are more expressed on a front surface since from above and behind heart is protected by the main vessels. Other option of an injury — water hammer on the lower surface through a diaphragm at a seat belt injury. At the vast majority of stupid injuries (78%) the main clinical implication — the heart bruise which is followed by epicardial and myocardial hemorrhages, and also local hypostasis without signs IT or with sites of a necrosis of various size. At a heart bruise perfusion of a myocardium because of redistribution of volumes of microcirculation from the functioning capillaries in arteriovenous shunts, and also from subendocardial departments in subepicardial for the second time is broken that can lead to development of a rupture of a wall of heart, secondary Of the Mechanism, at a stupid injury consists in sharp increase in pressure in heart cameras at its front-back compression or sharp inflow of blood from the lower vena cava at a seat belt injury.
Treatment of the Stupid injury of heart:
At a stable hemodynamics and absence according to noninvasive researches of gaps and bruises of large volume of special treatment it is not required. In case of the large volume of a bruise, and also at high risk of disturbances of a rhythm intensive observation, monitoring of a hemodynamics and normalization of content of potassium and magnesium in plasma are necessary. Cardiopulmonary resuscitation, recovery of water and electrolytic and acid-base disturbances, transfusions, hold treatment of disturbances of a rhythm, an acute heart failure and other intensive events at cardiorrheses for standard protocols. Purpose of lidocaine for prevention of ventricular tachycardia does not influence survival. At treatment of disturbances of a rhythm it is necessary to avoid use of drugs with a negative inotropic effect.
