Clinical and electrocardiographic features of complete heart block after blunt cardiac injury: A systematic review of the literature

Ali, Hussam; Furlanello, F; Lupo, Pierpaolo; Foresti, Sara; Ambroggi, Guido De; Epicoco, Gianluca; Semprini, Lorenzo; Fundaliotis, Angelica; Cappato, Riccardo

doi:10.1016/j.hrthm.2017.05.040

Cited by 16 publications

(18 citation statements)

References 52 publications

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“…Despite being rare, a variety of conduction disturbances have been reported with traumatic blunt cardiac injury. 1 High-grade AV block has also been reported in human studies and animal models following nonpenetrating injury and myocardial contusion. 2,3 Most of these anomalies occur immediately after or within 72 hours of blunt cardiac injury.…”

Section: Discussionmentioning

confidence: 95%

“…2,3 Most of these anomalies occur immediately after or within 72 hours of blunt cardiac injury. 1 While high-grade AV block after blunt cardiac injury is generally transient, and normal conduction returns after a period of a few days, in some patients-such as ours-the AV clock recurs or persists for more extended periods, requiring PPM insertion. 1 In our case, the decision to proceed with PPM placement was related to the recurrence of the episodes.…”

Section: Discussionmentioning

confidence: 99%

“…Multiple mechanisms have been proposed to explain this phenomenon, including injuries of cardiac structures that are in close anatomic relation with AV conductive systems, such as tricuspid valve damage and interventricular septum through acceleration/deceleration phenomenon or a direct injury to the chest. 1,4 Other explanations might be the disruption of the vagal sympathetic response or direct interference to the neuromuscular mechanisms of the heart, resulting in cardiac standstill and other conduction disturbances. 1,4 Echocardiograms can show abnormal septal motion in addition to right ventricle or tricuspid valve injuries; nevertheless, an unremarkable echocardiogram with relevant abnormalities is not uncommon.…”

Section: Discussionmentioning

confidence: 99%

“…1,4 Other explanations might be the disruption of the vagal sympathetic response or direct interference to the neuromuscular mechanisms of the heart, resulting in cardiac standstill and other conduction disturbances. 1,4 Echocardiograms can show abnormal septal motion in addition to right ventricle or tricuspid valve injuries; nevertheless, an unremarkable echocardiogram with relevant abnormalities is not uncommon. 1 PPM placement is usually indicated in patients with prolonged or recurrent high-grade AV block.…”

Section: Discussionmentioning

confidence: 99%

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Trauma-Induced Conduction Disturbances

Soud

Alrifai

Kabach

et al. 2018

TOJ

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Background: Electrical disturbances following blunt cardiac injuries are rare but can be caused by electrical or structural damage to the heart. We present the case of a patient who had conduction abnormalities following blunt traumatic injury that were incidentally detected on telemetry. Case Report: A 64-year-old female with no history of cardiac disease was brought to the emergency department after a motor vehicle collision that resulted in chest wall bruising. The patient was found to have L-spine fractures and was admitted for observation. During her hospitalization, the patient had multiple episodes of heart block. A temporary pacemaker was inserted because of the recurrent episodes, and a dual-chamber permanent pacemaker was placed on day 4 of her hospitalization. Conclusion: Heart block as a consequence of blunt cardiac injury is rare; however, it needs to be recognized as early as possible. Permanent pacemaker placement is usually indicated for patients with prolonged or recurrent episodes.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Trauma-Induced Conduction Disturbances

Soud

Alrifai

Kabach

et al. 2018

TOJ

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“…The most vulnerable cycle might be end-diastole when the impact of the BCT increases intraventricular pressure due to the mechanical compression of the distended ventricles 13. A complete heart block during BCT can be caused by either electrical or structural injury to the heart 14. In contrast to contusio cordis with predominantly structural character of the damage, commotio cordis might cause sudden death after the blunt impact on the precordium with subsequent ventricular fibrillation even without any evidence of structural injury to the myocardium 14 15.…”

Section: Introductionmentioning

confidence: 99%

Blunt chest trauma: a clinical chameleon

Eghbalzadeh

Sabashnikov

Zeriouh

et al. 2017

Heart

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The incidence of blunt chest trauma (BCT) is greater than 15% of all trauma admissions to the emergency departments worldwide and is the second leading cause of death after head injury in motor vehicle accidents. The mortality due to BCT is inhomogeneously described ranging from 9% to 60%. BCT is commonly caused by a sudden high-speed deceleration trauma to the anterior chest, leading to a compression of the thorax. All thoracic structures might be injured as a result of the trauma. Complex cardiac arrhythmia, heart murmurs, hypotension, angina-like chest pain, respiratory insufficiency or distention of the jugular veins may indicate potential cardiac injury. However, on admission to emergency departments symptoms might be missing or may not be clearly associated with the injury. Accurate diagnostics and early management in order to prevent serious complications and death are essential for patients suffering a BCT. Optimal initial diagnostics includes echocardiography or CT, Holter-monitor recordings, serial 12-lead electrocardiography and measurements of cardiac enzymes. Immediate diagnostics leading to the appropriate therapy is essential for saving a patient's life. The key aspect of the entire management, including diagnostics and treatment of patients with BCT, remains an interdisciplinary team involving cardiologists, cardiothoracic surgeons, imaging radiologists and trauma specialists working in tandem.

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Blunt Cardiac and Aortic Injuries

Gore

Coleman²

2022

Management of Chest Trauma

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Clinical and electrocardiographic features of complete heart block after blunt cardiac injury: A systematic review of the literature

Cited by 16 publications

References 52 publications

Trauma-Induced Conduction Disturbances

Trauma-Induced Conduction Disturbances

Blunt chest trauma: a clinical chameleon

Blunt Cardiac and Aortic Injuries

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