Dikkat: Kardiyak kontüzyon

AMAÇ: Ýzole künt toraks travmasýnda kardiyak kontüzyonlu hastalarýn taný ve klinik sürecini ortaya koymaktýr.
GEREÇ VE YÖNTEM: Bu çalýþma, acil týp bölümüne izole künt toraks travmasý sonrasý gelen 65 hasta üzerinde geriye dönük olarak gerçekleþtirildi. Tomografi görüntüleri, kardiyak enzim düzeyleri, periyodik dört saatlik EKG ve baþvuru sýrasýnda ve gerektiðinde klinik duruma göre yapýlan ekokar-diyografi sonuçlarý incelendi. Bir saatlik ve dört saatlik yüksek hassasiyetli troponin I seviyeleri çalýþýldý ve 0.04 ng/ml’nin üzerindeki deðerler pozitif olarak kabul edildi.
BULGULAR: Çalýþmaya alýnan, toraks travmasý geçiren 65 hastanýn 23’ünde (%35.38) hem pulmoner hem de kardiyak kontüzyon vardý. Yirmi üç hastada (%35.38) pulmoner kontüzyon mevcuttu ve ilk deðerlendirmede kardiyak kontüzyon tespit edilmedi. Bununla birlikte, klinik takip sýra-sýnda troponin pozitifleþmesi- aritmi geliþti ve bu hastalarýn dördünde travmaya baðlý kardiyak etkilenme görüldü. Altý hastada (%9.24) pulmoner kontüzyon olmadan kardiyak kontüzyon saptandý. On üç (%20) hastada kardiyak veya pulmoner kontüzyon saptanmadý. Hastaneye yatýþ sýrasýnda pulmoner kontüzyon, hemotoraks ve/veya pnömotoraks olan ve ardýndan dört saatlik kontrolde troponin seviyeleri normal olan 10 hastada kardiyak kontüzyon tanýsý olmadan troponin yüksekliði saptandý. Sonuçlar deðerlendirildiðinde, dördüncü saat sonuçlarýnda kardiyak kontüzyon ile troponin-EKG arasýnda istatistiksel uyum tespit edildi
TARTIÞMA: Tüm künt toraks travmasý geçiren hastalarda EKG ve troponin düzeylerinin takibi ile kardiyak kontüzyon açýsýndan taranmalarý öneriyoruz.

Attention: Cardiac contusion

BACKGROUND: The objective of the study is to investigate diagnostic and clinical processes performed for cardiac contusion in patients with blunt thoracic trauma.
METHODS: This study was conducted retrospectively on 65 patients admitted with isolated blunt thoracic trauma to the Emergency Medicine Department. The CT images, the cardiac enzyme levels, the periodic 4-h follow-up electrocardiography (ECGs) in the emer-gency department, and the results of echocardiography, performed at admission and when required according to the clinical status, were investigated. The 1-h and 4-h high-sensitivity troponin I levels were studied, and values above 0.04 ng/ml were considered as positive.
RESULTS: Sixty-five patients with isolated thoracic trauma were included in the study, 23 (35.38%) had pulmonary and cardiac contu-sions both. In 23 (35.38%) patients, pulmonary contusion had been present, and cardiac contusion had not been identified at the initial evaluation. However, during clinical follow-up, troponin became positive, dysrhythmia developed, and the trauma affected the heart in four of these patients. In six (9.24%) patients, cardiac contusion was identified without pulmonary contusion. In 13 (20%) patients, no cardiac or pulmonary contusion was identified. troponin elevation was detected in 10 patients without a diagnosis of cardiac contusion who had a pulmonary contusion, hemothorax, and/or pneumothorax at the time of hospital admission and then with normal troponin levels at 4-h control. We found that there was a statistical agreement between cardiac contusion and troponin-ECG results at 4th h.
CONCLUSION: We advise that all blunt thoracic trauma patients should be screened for cardiac contusion by continuous ECG monitoring and troponin levels.