Alteraciones electrofisiológicas y/o bioquímicas del trauma cardíaco / Electrophysiological and/or biochemical alterations of cardiac trauma

Resumen El trauma cardíaco constituye una de las primeras causas de mortalidad en la población general. La gran mayoría son causados por accidentes automovilísticos. Su diagnóstico es difícil y requiere alto índice de sospecha en trauma cerrado. Posee un índice de mortalidad muy elevado, cercano al 76%. Existen varios métodos diagnósticos disponibles para facilitar su detección pero ninguno logra alcanzar una sensibilidad cercana al 100%. El trauma cardíaco contuso puede variar desde lesión cardíaca asintomática hasta ruptura cardíaca y muerte. Actualmente se utilizan marcadores bioquímicos como enzimas cardíacas, siendo la Troponina I la más específica; y electrofisiológicos como hallazgos en el electrocardiograma sugestivos de bloqueo de rama y taquicardia sinusal, siendo estos los más frecuentemente encontrados.

Abstract Heart trauma is one of the leading causes of mortality in the general population. The vast majority are caused by automobile accidents. Its diagnosis is difficult and requires a high index of suspicion in closed trauma. It has a very high mortality rate, close to 76%. There are several diagnostic methods available to facilitate its detection, but none can reach a sensitivity close to 100%. Contusive heart trauma can range from asymptomatic cardiac injury to cardiac rupture and death. Currently, biochemical markers are used as cardiac enzymes, with Troponin I being the most specific; and electrophysiological findings in the electrocardiogram suggestive of branch block and sinus tachycardia, these being the most frequently found.

A combination of methylprednisolone and quercetin is effective for the treatment of cardiac contusion following blunt chest trauma in rats

Cardiac contusion is a potentially fatal complication of blunt chest trauma. The effects of a combination of quercetin and methylprednisolone against trauma-induced cardiac contusion were studied. Thirty-five female Sprague-Dawley rats were divided into five groups (n=7) as follows: sham, cardiac contusion with no therapy, treated with methylprednisolone (30 mg/kg on the first day, and 3 mg/kg on the following days), treated with quercetin (50 mg·kg−1·day−1), and treated with a combination of methylprednisolone and quercetin. Serum troponin I (Tn-I) and tumor necrosis factor-alpha (TNF-α) levels and cardiac histopathological findings were evaluated. Tn-I and TNF-α levels were elevated after contusion (P=0.001 and P=0.001). Seven days later, Tn-I and TNF-α levels decreased in the rats treated with methylprednisolone, quercetin, and the combination of methylprednisolone and quercetin compared to the rats without therapy, but a statistical significance was found only with the combination therapy (P=0.001 and P=0.011, respectively). Histopathological degeneration and necrosis scores were statistically lower in the methylprednisolone and quercetin combination group compared to the group treated only with methylprednisolone (P=0.017 and P=0.007, respectively). However, only degeneration scores were lower in the combination therapy group compared to the group treated only with quercetin (P=0.017). Inducible nitric oxide synthase positivity scores were decreased in all treatment groups compared to the untreated groups (P=0.097, P=0.026, and P=0.004, respectively). We conclude that a combination of quercetin and methylprednisolone can be used for the specific treatment of cardiac contusion.

Correlation Between Pulmonary Contusion and Myocardial Contusion in Patients with Multiple Injuries

PURPOSE: This study was conducted to evaluate the correlations among pulmonary contusion severity, trauma score and cardiac troponin I (cTnI) level. METHODS: We prospectively evaluated patients with multiple injuries who had been admitted to the emergency department (ED) from July 2007 to July 2008. We first measured the total creatinine kinase (CK), the MB fraction of CK (CK-MB), TnI, and myoglobin within 2 hours after the injury. We then checked the electrocardiogram, x-ray, and computed tomography (CT) results. Finally, we assessed the injuries as variables and then compared the results for patients with elevated TnI levels (group A) and patients whose TnI levels fell within the normal range (group B). RESULTS: Eighty-six of the 92 patients admitted to the ED were enrolled. The pulmonary contusion score (PCS) was well correlated with PaO2/FiO2. TnI levels were correlated with PCS. When TnI levels were above 0.86 ng/ml, the mortality was estimated with 100% sensitivity and 86.1% specificity. CONCLUSION: Pulmonary contusion severity is correlated with TnI level. When the PCS is high and the cTnI level is elevated in multiple-injury patients, we recommend continuous cardiac monitoring and further evaluation.

THE ESTABLISHMENT OF EXPERIMENTAL ANIMAL MODEL OF CARDIAC CONTUSION / 中国法医学杂志

In the present study an experimental animal model of closed chest cardiac contusion in dogs was successfully established by impacting precardial area at the velocity of 9- 1 - 10. 5m/s with home-made elastic cord propelled impactor, After impact, some significant abnormalities of the left and right ventricular pressure,ECG and heart rate were recorded. Cardiac contusions were demonstrated at au-topsy. The establishment of the experimental cardiac contusion model could provide the tool for further study on nonpenetrating cardiac injury.