Ferimento cardíaco transfixante por projétil de arma de fogo: relato de caso

Abstract

Penetrating cardiac trauma carries high mortality rates. It has been commonly associated with stabbing, but increasing urban violence has led to growing numbers of gunshot heart wounds. The latter have higher mortality rates among penetrating cardiac injuries and may affect multiple heart chambers, with even higher mortality rates. We report a patient, victim of an attempted armed robbery, who had a transfixing gunshot wound to the heart, successfully operated at our institution.Descriptors: Heart injuries. Wounds, gunshot. Heart ventricles. ResumoO trauma cardíaco penetrante apresenta altas taxas de mortalidade. É comumente associado a lesões por armas brancas, porém crescentes índices na violência urbana têm contribuído para o aumento no número de ferimentos cardíacos por projéteis de armas de fogo. Estas possuem as maiores taxas de mortalidade dentre os ferimentos cardíacos penetrantes e podem acometer múltiplas câmaras cardíacas, com índices de mortalidade ainda mais elevados. Apresentamos um caso de um paciente, vítima de tentativa de roubo, que sofreu ferimento cardíaco transfixante por projétil de arma de fogo, operado com sucesso em nossa instituição.Descritores: Traumatismos cardíacos. Ferimentos por arma de fogo. Ventrículos do coração.

Heart Injury with Projectile Lodged Inside the Heart

“…Despite the improvement in trauma patient care, a large number of victims of penetrating cardiac injuries die before their admission to a hospital [ 1 ] . Most are caused by white weapons or firearm projectiles [ 1 , 2 ] , although such injuries may also be caused by foreign bodies, costal or sternal fractures [ 1 ] under more rare circumstances. Penetrating cardiac injuries by white weapons are more frequent than firearms, but the increase in urban violence rates has contributed to the growing importance of the firearms injuries [ 1 , 3 ] .…”

“…The high number of deaths in the prehospital phase impairs the calculation of the real mortality rates, but values are estimated between 16% to 97% [ 1 ] . The mechanism of trauma, the clinical conditions at hospital admission, and the presence of lesions in multiple cardiac chambers are the most important variables for the determination of the outcome in these patients [ 1 , 2 ] . The main causes of death are the hypovolemic shock due to exsanguination, and the cardiac tamponade [ 2 ] .…”

“…The mechanism of trauma, the clinical conditions at hospital admission, and the presence of lesions in multiple cardiac chambers are the most important variables for the determination of the outcome in these patients [ 1 , 2 ] . The main causes of death are the hypovolemic shock due to exsanguination, and the cardiac tamponade [ 2 ] . Currently, heart injuries have been more common due to the rampant growth of urban violence and the easy access of the civilian population to firearms [ 1 , 3 ] .…”

Transfixing cardiac injury with perforations in stomach, diaphragm and lung: unusual scenario in penetrating trauma

“…Therefore, little is known about real mortality rates - prehospital mainly - of penetrating cardiac injuries [ 1 , 2 ] . The most frequent causes are injuries caused by knives and guns, mainly due to increasing urban violence [ 1 - 3 ] .…”

“…The nature of the injury itself, the involvement of an organ as vital as the heart as well as rapid clinical deterioration all cooperate to unfavorable outcomes in both prehospital and inhospital environments. In addtion, the rampant growth of urban violence and increased access of civilians to firearms have contributed to the increased incidence of penetrating cardiac injuries [ 1 - 3 ] .…”