Mycardial Rupture


Background
  1. Acute traumatic cardiac perforation
  2. Usually immediately fatal
  3. Common mechanisms

Pathophysiology

  1. Structures involved
  2. Survivability
  3. Injury mechanisms
  4. Associated injuries

Diagnostics

  1. History / physical
      • Hypotension
      • Elevated CVP / distended neck veins
      • Tachycardia
      • Cyanosis
        • Head and neck
        • Upper arms, chest
      • Distant heart sounds
      • Chest contusions
      • Other associated chest injuries
      • Auscultation: "Bruit de moulin"
        • Harsh murmur
        • Sounds like splashing "mill wheel"
        • May hear metallic "tinkling"
          • Due to hemopneumopericardium
  2. Diagnostic testing
  3. Diagnostic imaging

Differential Diagnosis

  1. Cardiac tamponade
  2. Tension pneumothorax
  3. Aortic rupture
  4. Exsanguination

Treatment

  1. Initial ATLS primary survey / resuscitation
  2. Direct treatment to relieve tamponade / stop bleeding
  3. If rupture identified
      • Atrial ruptures
        • Vascular clamps
        • Finger pressure
        • Foley catheter in hole
      • Ventricular ruptures
        • Finger pressure
        • Non-absorbable vascular sutures with pledgets
  4. Definitive treatment is cardiac surgery
  5. Tetanus prophylaxis

Disposition

  1. Admit: OR usually required emergently