Cardiac tamponade due to right atrial rupture

Abstract

Cardiac tamponade is a cardiac emergency that requires urgent intervention. Cardiac tamponade due to penetrating cardiac injury requires urgent thoracotomy. As per the guidelines, pericardiocentesis can be done as a bridge to thoracotomy. However, no clear guidelines exist on the management of cardiac tamponade due to blunt cardiac injury. In the following case report, we propose a management plan for blunt cardiac injury in the emergency department. In the following case report, we describe a patient with a road traffic accident who had a blunt cardiac injury and had cardiac tamponade for whom we did not do emergency pericardiocentesis. Instead, we managed the patient with iv fluids and blood transfusion and the patient was taken up for immediate emergency thoracotomy. Not all cardiac tamponade requires pericardiocentesis. Cardiac tamponade due to injury to the low-pressure system can be best managed by initial resuscitation followed by emergency thoracotomy. We also propose a management plan for managing a patient with cardiac tamponade due to blunt cardiac injury when the injury can be visible in the low-pressure chambers.

Isolated Right Atrial Appendage Rupture from Blunt Chest Trauma: A Case Report

“…Cardiac trauma is a relatively less common consequence of blunt injury, occurring in less than 10% of trauma admissions; however, it is associated with high rates of morbidity and mortality. Approximately 25% of traumatic deaths occur due to cardiac-related injuries [9,10]. Isolated right atrial rupture from blunt chest trauma is a rare (0,5% of blunt chest trauma cases) but serious condition that requires prompt diagnosis and treatment and it can occur in the absence of any external signs of trauma.…”

“…Moreover, the initial symptoms may be non-specific and can mimic other conditions and there is no universally accepted diagnostic criteria for the assessment of atrial rupture as there have been many documented presentations for such an injury in the literature [18]. The diagnosis of blunt cardiac injury remains difficult due to other associated injuries that divert the physician's attention, as well as the lack of specific physical findings and the lack of clinical suspicion of a specialized physician in an emergency room for the diagnosis of such an injury [10,6]. According to Muna Al Ayyan et al [6], it is worth mentioning that the experience of a general surgeon who works in a hospital lacking a surgical cardiovascular section plays a vital role in evaluating and determining the proper treatment for patients experiencing cardiac and/ or vascular issues.…”

“…According to many authors [10,6,9,12], imaging studies such as echocardiography, CT scans, and MRI can help confirm the diagnosis and determine the extent of the injury if the hemodynamic status is stable. This patient initially had a stable status that was permitted to carry out a thoracic CT scan with contrast agent showing the sign of extravasation into pericardial space that is extremely clear and specific sign of cardiac rupture.…”

“…Prompt diagnosis and treatment can improve the chances of survival by nearly 80% for patients suffering from this type of devastating injury [6]. In case of cardiac rupture suspected, median sternotomy is the approach most commonly utilized as it allows for quick, easy and adequate exposure of the heart and great vessels [3,10,11]. This approach can be useful in case of extracorporeal circulation is needed, in particular complex cardiac injuries such as multiple lacerations, ventricular ruptures, atrio-vena cava junction tear or coronary injuries, etc.…”