Cardiac evaluation following heart injury

J Trauma. 1985 Aug;25(8):758-65. doi: 10.1097/00005373-198508000-00005.


Both penetrating and blunt cardiac injuries require urgent management. Delayed sequelae and complications have been reported to occur in 4 to 56% of survivors and frequently required secondary surgical corrections. Between January 1980 and June 1984, 204 patients presented with heart injuries. One hundred twenty-eight of these patients survived. Of the 90 undergoing cardiorrhaphy in the operating room, 78 survived. Two-dimensional (2-D) and pulsed-Doppler echocardiography (echo) and/or cardiac catheterization were performed in 40 patients for suspected significant residual injury. Eight of the 40 required secondary cardiac operations. Two-dimensional echo demonstrated pericardial effusion, abnormal chamber enlargement, abnormal cardiac wall motion, intracardiac missile, and intracardiac and pleural thrombus. Pulsed-Doppler findings included ventricular septal defect, tricuspid insufficiency and right ventricular turbulence secondary to arteriovenous fistulae. Cardiac catheterization detected lesions undetected by 2-D echo in one patient with a gunshot wound. It is concluded that in the absence of cardiac bullets seen on routine chest X-ray, 2-D with pulsed-Doppler echo is an excellent screening technique. With a positive echo study or a residual bullet overlying the cardiac silhouette, cardiac catheterization is indicated in selected patients.

MeSH terms

  • Adolescent
  • Adult
  • Cardiac Catheterization
  • Child
  • Child, Preschool
  • Echocardiography
  • Female
  • Heart Injuries / diagnosis*
  • Humans
  • Male
  • Middle Aged
  • Wounds, Gunshot / diagnosis