Subject(s)
Dyspnea/etiology , Hernia, Hiatal/complications , Takotsubo Cardiomyopathy/complications , Aged, 80 and over , Dyspnea/diagnostic imaging , Dyspnea/surgery , Female , Hernia, Hiatal/diagnostic imaging , Hernia, Hiatal/surgery , Humans , Radiography , Takotsubo Cardiomyopathy/diagnostic imaging , Takotsubo Cardiomyopathy/surgeryABSTRACT
We report here an uncommon anterior chest trauma with an unusual fatal penetrating coronary artery injury by pneumatic nail gun with effective perioperative management. While doing upholstery, a 32-year-old male patient accidentally stabbed by a pneumatic nail gun with injury to the anterior chest was brought to the emergency room of our hospital. Persistent chest pain with unstable vital signs and no external injury except for a faint ecchymosis on anterior chest were noted at arrival. Sixty-four-slice computed tomography (CT) scan revealed a foreign body completely embedded in the chest wall penetrating the left ventricle, with the coronary artery also suspected of being involved because of ST-T changes of V2 to V6 on electrocardiography. Three-dimensional reconstructive CT scans showed a penetrating injury to the left anterior descending coronary artery without complete transection. Thereafter, we performed the operation of nail removal with direct repair of coronary artery that was scheduled based on the image findings preoperatively, and the operation was smoothly performed without coronary artery cardiopulmonary bypass and grafting bypass effectively and simply. He was discharged uneventfully 14 days later. Another CT scan was performed which showed patency of repaired coronary artery 3 months later.
Subject(s)
Coronary Vessels/injuries , Wounds, Penetrating/surgery , Adult , Coronary Angiography/methods , Coronary Vessels/surgery , Foreign Bodies/diagnostic imaging , Foreign Bodies/etiology , Foreign Bodies/surgery , Heart Ventricles , Humans , Image Interpretation, Computer-Assisted/methods , Male , Perioperative Care/methods , Tomography, X-Ray Computed , Wounds, Penetrating/diagnostic imagingABSTRACT
Accurate diagnosis of wide QRS complex tachycardia is difficult in emergent situations. According to the Advanced Cardiac Life Support (ACLS) tachycardia algorithm of the American Heart Association, immediate synchronized cardioversion should be applied to patients with wide QRS tachycardia with any evidence of hemodynamic instability. However, this may not be appropriate in all patients, especially those with idiopathic left ventricular tachycardia. In our patient, repetitively synchronized cardioversion failed to convert the arrhythmia. It is important for emergency physicians to recognize the electrocardiographic features of idiopathic left ventricular tachycardia and to manage these patients appropriately.
Subject(s)
Electric Countershock , Hemodynamics , Tachycardia, Ventricular/therapy , Adult , Electrocardiography , Female , Humans , Tachycardia, Ventricular/physiopathologySubject(s)
Heart Arrest/chemically induced , Nuts/adverse effects , Piper betle/adverse effects , Ventricular Fibrillation/chemically induced , Drug Therapy, Combination , Electric Countershock , Electrocardiography , Emergency Service, Hospital , Follow-Up Studies , Heart Arrest/diagnosis , Heart Arrest/therapy , Humans , Male , Mastication , Middle Aged , Risk Assessment , Treatment Outcome , Ventricular Fibrillation/diagnosis , Ventricular Fibrillation/therapyABSTRACT
With the increase in the number of automobile accidents, traumatic tricuspid insufficiency, a rare complication of non-penetrating blunt chest injury, has become an important problem. This kind of injury has been found more frequently during the last decade, partly because of better diagnostic procedures and a better understanding of the pathology. Here, we report a 22-year-old male patient who suffered chest trauma from an automobile accident. Echocardiography demonstrated tricuspid chordae tendinae rupture with remarkable tricuspid regurgitation. We discuss this case in comparison with the previous literature. This case reminds us that physicians in the emergency department should be aware of this potential complication following non-penetrating chest trauma.
