TY - CHAP M1 - Book, Section TI - TRAUMATIC HEART DISEASE A1 - Ferguson, Jr., T. Bruce A2 - Fuster, Valentin A2 - Harrington, Robert A. A2 - Narula, Jagat A2 - Eapen, Zubin J. Y1 - 2017 N1 - T2 - Hurst's The Heart, 14e AB - SummaryThis chapter discusses traumatic injury to the heart and the great vessels. Thoracic injuries are a contributing factor in up to 75% of all trauma-related deaths. Causes of traumatic cardiovascular injury can be broadly classified into having arisen from penetrating or blunt mechanisms (see accompanying Hurst’s Central Illustration). Penetrating injuries to the heart and great vessels are associated with high mortality; early diagnosis is critical for survival and penetrating cardiovascular injuries should therefore be suspected with any missile or knife wound to the thorax or upper abdomen. Repair is often performed through a left thoracotomy in the emergency department. If patients with a penetrating heart injury are sufficiently stable, a median sternotomy in the operating room is preferred. Blunt injury requires significant force, such as occurs in motor vehicle crashes or falls from heights. Diagnosis of blunt trauma to the heart can be difficult, because a majority of patients are asymptomatic. In cases of blunt heart injury with severe ventricular dysfunction and low cardiac output, inotropic support is appropriate and, if no satisfactory improvement occurs, intra-aortic balloon counterpulsation should be considered. Emergency surgical intervention via sternotomy is mandatory for pericardial rupture. Management options for blunt trauma to the great vessels include immediate repair through a left thoracotomy, delayed repair in multiply injured patients requiring ongoing resuscitation, or endovascular stent graft insertion in selected patients. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/28 UR - accesscardiology.mhmedical.com/content.aspx?aid=1191188693 ER -